Abstract
Background
Critical central airway obstruction (CAO) requires emergent airway intervention, but
current guidelines lack specific recommendations for airway management in the emergency
department (ED) while awaiting rigid bronchoscopy. There are few reports of the use
of noninvasive ventilation (NIV) in tracheomalacia, but its use as a temporizing treatment
option in fixed, malignant CAO has not, to the best of our knowledge, been reported.
Case Report
An 84-year-old woman presented to the ED in respiratory distress, too breathless to
speak and using her accessory muscles of respiration, with bilateral rhonchi throughout
the lung fields. Point-of-care arterial blood gas revealed severe hypercapnia, and
NIV was initiated to treat a presumed bronchitis with hypercapnic respiratory failure.
Chest radiography revealed a paratracheal mass with tracheal deviation and compression.
A diagnosis of critical CAO was made. While arranging for rigid bronchoscopic stenting,
the patient was kept on NIV to good effect.
Why Should an Emergency Physician Be Aware of This?
Recommendations for emergent treatment of life-threatening, critical CAO before bronchoscopic
intervention are not well established. Furthermore, reports of NIV use in CAO are
rare. We suggest that emergency physicians consider NIV as a temporizing measure for
critical CAO while awaiting availability of bronchoscopy.
Keywords
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Article info
Publication history
Published online: February 23, 2018
Accepted:
December 30,
2017
Received in revised form:
October 30,
2017
Received:
July 7,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
