Awake emergency endotracheal intubation using sheath-assisted technique for patients having malignant tracheal stenosis under fluoroscopy guidance: a retrospective study

Abstract

Background

For patients having a severe larynx or tracheal stenosis, emergency endotracheal intubation (EEI) may be needed due to respiratory failure.

Purpose

To evaluate the feasibility and effectiveness of awake EEI using a fluoroscopy-guided sheath-assisted technique for adult patients having a malignant tracheal stenosis.

Material and Methods

From October 2009 to May 2015, 219 patients having a malignant tracheal stenosis causing dyspnea or asphyxia required EEI. Of these, 32 patients who experienced intubation difficulties or failure were included in this study. Data on the technical success, procedure time, complications, and clinical outcome were collected. The pulse oxygen saturation (SpO₂) and Hugh-Jones classification were used to evaluate the respiratory function before and after EEI.

Results

Awake fluoroscopy-guided EEI was technically successful in 15 ± 4 min and acute dyspnea was resolved in all patients. The SpO₂ and Hugh-Jones classification increased after EEI (P < 0.05). Subsequent treatments included tracheal stents (n = 15), surgical resection (n = 10), and palliative tracheotomy (n = 7), which were performed within 72 h after EEI.

Conclusion

Awake EEI using a sheath-assisted technique for adult patients having a malignant tracheal stenosis is a safe and effective procedure.

Keywords

Thorax fluoroscopy interventional stents

Get full access to this article

View all access options for this article.

References

Mason

Weant

Baker

. Rapid sequence intubation medication therapies: a review in light of recent drug shortages. Adv Emerg Nurs J 2013; 35: 16–25; quiz 26–17.

Tourtier

Falzone

Hoffmann

. Rapid sequence intubation: a safe and effective technique. J Intensive Care Med 2012; 27: 66–67.

Wei

. Laryngoscope and a new tracheal tube assist lightwand intubation in difficult airways due to unstable cervical spine. PLoS One 2015; 10: e0120231–e0120231.

Han

. Sheath-assisted tracheal intubation: A further treatment option for patients with acute dyspnea or asphyxia caused by severe stenosis of the larynx or trachea. Ann Thorac Surg 2011; 92: 710–713.

Sun

Xue

. Awake fiberoptic intubation without complaints. J Clin Anesth 2015; 27: 616–617.

Thornton

Yunker

. Rigid bronchoscopy and balloon dilation for removal of aspirated thumbtacks: Case series and literature review. Int J Pediatr Otorhinolaryngol 2015; 79: 1541–1543.

Del Valle

Cosío

Soto

. Nasotracheal intubation with fibrobronchoscopy as the only possibility in a patient with ankylosis of the temporomandibular joint. Rev Esp Anestesiol Reanim 2012; 59: 525–525.

Choi

Kang

. A randomized comparison simulating face to face endotracheal intubation of Pentax Airway Scope, C-MAC Video Laryngoscope, Glidescope Video Laryngoscope, and Macintosh Laryngoscope. Biomed Res Int 2015; 2015: 961782–961782.

Kim

Shin

Kim

. Management of tracheal obstruction caused by benign or malignant thyroid disease using covered retrievable self-expandable nitinol stents. Acta Radiol 2010; 51: 768–774.