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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
A 54-Year-Old Male With Persistent Air Leak After Endotracheal Intubation
Angela Montes1, Rodrigo Garcia Tome2, William West3
1Department of Internal Medicine University of Southern California Los Angeles California USA.
None:
Tracheoesophageal fistulas (TEFs) are abnormal communications between the trachea and oesophagus that may be congenital or acquired. Clinical presentation can be subtle and nonspecific. We report a case of a 54-year-old male with advanced HIV, end-stage renal disease and multiple comorbidities who developed a persistent air leak after emergent intubation following cardiac arrest. Despite endotracheal tube exchange, the air leak persisted and was accompanied by marked abdominal distension. Computed tomography (CT) imaging revealed a tracheal defect near the left mainstem bronchus and bronchoscopy confirmed a TEF. The patient underwent oesophageal stent placement; however, methylene blue testing demonstrated a persistent communication between the oesophagus and airway. Given his poor overall prognosis, the family opted to withdraw life-sustaining treatment. This case highlights the importance of considering TEF in mechanically ventilated patients with persistent air leak unresponsive to tube exchange.
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