Korean J Crit Care Med.  2015 May;30(2):135-138. 10.4266/kjccm.2015.30.2.135.

Successful Management of Airway Emergency in a Patient with Esophageal Cancer

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. hjleedr@gmail.com

Abstract

A 60-year-old man with advanced esophageal cancer was admitted for surgical placement of a feeding jejunostomy tube before commencement of chemoradiotherapy. His esophageal cancer had directly invaded the posterior tracheal wall, inducing a nearly total obstruction of the distal trachea. On the day before the surgery, respiratory failure developed due to tumor progression and tracheal edema. Tracheal intubation and mechanical ventilation were attempted without success. Application of veno-venous extracorporeal membrane oxygenation (ECMO) corrected the patient's respiratory acidosis and relieved his dyspnea. With full ECMO support, he underwent tracheal stent insertion. Two hours later, he was weaned from ECMO support uneventfully. This was a successful case of tracheal stenting for airway obstruction under rescue veno-venous ECMO.

Keyword

airway management; esophageal neoplasm; extracorporeal membrane oxygenation; tracheal stenosis

MeSH Terms

Acidosis, Respiratory
Airway Management
Airway Obstruction
Chemoradiotherapy
Dyspnea
Edema
Emergencies*
Esophageal Neoplasms*
Extracorporeal Membrane Oxygenation
Humans
Intubation
Jejunostomy
Middle Aged
Respiration, Artificial
Respiratory Insufficiency
Stents
Trachea
Tracheal Stenosis

Figure

  • Fig. 1. CT scans show the narrowest tracheal lumen. (A) Axial view. The diameter of tracheal lumen was measured 5 mm. (B) Sagittal view.

  • Fig. 2. CT scans during stenting. (A) Pre-procedure CT scan shows pin point tracheal lumen, which was much narrower compared with Fig. 1A. (B) Post-procedure CT scan shows a widen lumen, which was measured 8 mm.


Reference

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