Colbert Perez MDa, Ralph Paone MDb, Raed Alalawi MDa
Correspondence to Colbert Perez
SWRCCC : 2013;1.(2):26-27
A 43-year-old woman with a history of asthma presented with five months of worsening dyspnea unresponsive to her current asthma therapy. Her symptoms began one month after an asthma exacerbation that was complicated by pneumonia and required intubation. Upon arrival her oxygen saturations were 79%, and she had significant stridor and respiratory distress. A non-rebreather mask was required to maintain oxygen saturations above 90%. After being placed on a 70/30 heliox mixture, her work of breathing greatly improved. Bronchoscopy and endoscopic treatment relieved her dyspnea (Figures1-3).
Figure 1 Initial bronchoscopy demonstrating tracheal stenosis with an airway size of 2-4mm
Figure 2 After balloon dilation with 15mm balloon and an approximate airway size of 10mm
Figure 2 After Endoscopic electrosurgery and balloon dilation
Adult tracheal stenosis secondary to intubation has a reported incidence of 0.6-21% and is presumed to be related to cuff injury in 31% of cases1. It may take 30 days to develop after extubation, and the diagnosis is best made by bronchoscopy 2. However, helical CT with reconstruction has 93% sensitivity and 100% specificity 3. Heliox mixtures can reduce the work of breathing in the acute setting and helped in this case. The low density of heliox reduces turbulent airflow which decreases airway resistance, pleural pressure swings, and dynamic hyperinflation 4. The best treatment for adult tracheal stenosis is endobronchial laser resection, but complex lesions may require surgical resection and/or stents.
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- Feller-Koppman D, Odonnel C. Physiology and clinical use of heliox. UptoDate. Waltham, MA, 2013.
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