Open AccessDifficult positive pressure ventilation in an adult with a tracheostomy
Author(s) -
Li Li,
Dorsey David,
Meyer Tanya,
Bhananker Sanjay
Publication year - 2017
Publication title -
anaesthesia cases
Language(s) - English
Resource type - Journals
ISSN - 2396-8397
DOI - 10.21466/ac.dppviaa.2017
Subject(s) - tracheobronchomalacia , tracheomalacia , medicine , anesthesia , expiration , airway , ventilation (architecture) , bronchoscopy , exhalation , positive pressure , airway management , continuous positive airway pressure , hypocapnia , positive end expiratory pressure , laryngoscopy , mechanical ventilation , surgery , intubation , respiratory system , obstructive sleep apnea , mechanical engineering , acidosis , engineering , hypercapnia
Summary Tracheomalacia and tracheobronchomalacia are rare disorders of a weakened airway that predispose patients to excessive airway compression, typically during expiration. Recommended anaesthetic management includes continuous positive airways pressure or positive end‐expiratory pressure in order to maintain airway calibre. We present the case of a 57‐year‐old female with Weill‐Marchesani syndrome, tracheobronchomalacia, and a permanent tracheostomy in whom we experienced difficulty maintaining adequate ventilation, oxygenation, and tidal volumes with positive pressure ventilation during anaesthetic induction, which improved with restoration of spontaneous breathing. We liken this to the physiology of an anterior mediastinal mass and recommend a similar anaesthetic approach.