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Updated: Jan 17, 2026

Guidelines for Elective Pediatric Fiberoptic Intubation
11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

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Emergency bedside fibreoptic bronchoscopy for mucus plug-related dynamic airway obstruction causing extreme

Saurabh Trivedi1, Pooja Thaware1, Jitendra Kushwaha1

  • 1Trauma & Emergency Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India.

BMJ Case Reports
|January 14, 2026
PubMed

A woman in her 20s with tracheal stenosis following corrosive acid ingestion presented to the emergency department (ED) with acute respiratory failure 5 months after the initial injury, despite having a tracheostomy in situ. She had extreme hypercapnia (pCO2 198 mm Hg, pH 6.8) that persisted despite tracheostomy tube change and mechanical ventilation. Bedside flexible fibreoptic bronchoscopy revealed severe distal tracheal stenosis complicated by an adherent mucus plug creating a dynamic ball-valve obstruction. Ventilation improved only after clearance using an ultraslim 3.1 mm neonatal fibreoptic bronchoscope, with rapid normalisation of gas exchange within hours. This case highlights that dynamic mucus impaction in post-corrosive tracheal stenosis can cause immediately life-threatening but potentially reversible extreme hypercapnia and underscores the need for EDs managing complex airways to maintain ready access to paediatric and neonatal ultra-slim fibreoptic bronchoscopes.

Keywords:
Primary CareResuscitation

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