Non-invasive ventilation and airway exchange catheter using a novel adapter in a difficult airway patient with post-extubation respiratory failure

Post-extubation respiratory failure in patients with difficult airway is considered a challenge for the health team. Some intratracheal devices such as airway exchange catheters (AECs) could be used during scheduled tube removing to ensure a rapid access to airway in the case of requiring emergent reintubation. Nevertheless, using such devices could impede adequate non-invasive mechanical ventilation (NIMV) support because of the air leaks generated by interfering with mask interfaces. We describe the case of a woman with a very difficult airway in whom an AEC was placed before scheduled extubation and then developed post-extubation respiratory failure. Mask interface was adequately sealed by using a novel tube adapter for NIMV and successful non-invasive ventilation was provided while maintaining the AEC placed in the trachea until the emergency reintubation risk was overcome.