Airway Decision-Making in Acute Epiglottitis: A Case Report of Planned Tracheostomy in a Can Ventilate but Cannot...

Acute epiglottitis is a life-threatening emergency characterized by rapid airway obstruction and challenging airway management due to severe supraglottic edema. We report the case of a 22-year-old man who presented with acute epiglottitis complicated by extensive neck edema, inspiratory stridor, and progressive respiratory distress. Despite multiple attempts, endotracheal intubation failed because of severe epiglottic swelling obscuring the laryngeal inlet. However, effective bag-mask ventilation was maintained, resulting in a "can ventilate but cannot intubate" (CVCI) scenario rather than a "cannot intubate, cannot ventilate" (CICV) emergency. In accordance with difficult airway guidelines, further traumatic intubation attempts were avoided, and a planned bedside tracheostomy was successfully performed by an experienced otolaryngology surgeon with multidisciplinary support from emergency and anesthesiology teams. Oxygenation rapidly improved, and the patient recovered without complications. This case highlights the importance of accurate airway scenario recognition, preservation of oxygenation, avoidance of repeated intubation attempts, and early multidisciplinary collaboration in the management of difficult airways associated with acute epiglottitis.