Emergency airway management in a patient with acquired subglottic stenosis

Background: Acquired subglottic stenosis is a common complication of previous endotracheal intubation. This case highlights the importance of recognizing early symptom of airway obstruction in a patient with a history of intubation regardless of the time of symptoms onset or the duration of previous ventilation. Case report: A 21-year-old gentleman with a history of invasive ventilation post-traumatic brain injury one month ago presented to our center with stridor. On arrival, his oxygen saturation ranged between 75-85% and his arterial blood gas showed features of type II respiratory failure. Both endotracheal intubation and subsequent laryngeal mask airway insertion failed. ENT team was immediately called in and an emergency tracheostomy was performed by the bedside and the patient was successfully ventilated. Emergency direct laryngoscopy revealed a 1.2 cm diameter of subglottic stenosis, 1 cm distal from the vocal cord (Cotton-Myer Grade 2). Patient was discharged well after 6 days of hospitalization with tracheostomy tube-in-situ. Discussion: A high index of suspicion is warranted with the onset of respiratory symptoms following history of intubation. Patient with history of endotracheal intubation should be educated on symptoms of upper airway obstruction upon hospital discharge for early detection and management. (C) 2018 Indian Journal of Medical Specialities. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.