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Stenting of critical tracheal stenosis with adjuvant cardio-pulmonary bypass

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      Abstract

      Severe and critical central airway obstruction causing impaired ventilation and/or oxygenation can impose tremendous challenges on the interventional pulmonologist. Near total airway obstruction can rapidly evolve into potentially fatal complete airway occlusion during bronchoscopic airway manipulation under moderate sedation; as well as during the induction of the general anesthesia. Although there are currently interventional pulmonary procedures available to tackle the critical airway obstruction in extreme situations, cardio-pulmonary bypass should be considered prior to the intervention to maintain the adequate gas exchange during the procedure. Orotracheal intubation with mechanical ventilation in this situation can be fatal itself if the obstructing airway lesion functions as a “one way valve” allowing air to follow distally during inspiration but impeding expiratory flow leading to gas trapping, high intrathoracic pressure, tension pneumothorax, and ultimately a cardiac arrest.

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      Most cited references 7

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      Mediastinal mass resection: Femorofemoral cardiopulmonary bypass before induction of anesthesia in the management of airway obstruction.

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        The difficult airway: cardiopulmonary bypass--the ultimate solution.

        Large, compressive thyroid masses are usually removed as an elective procedure. Rarely is a patient's condition allowed to progress to severe respiratory distress before surgical intervention is recommended. When allowed to progress, management of the airway can be problematic. A case report of a patient with a neglected thyroid lymphoma is presented. The natural progression of the disease, leading to impending airway collapse, necessitated emergency management of the airway. Due to supraglottic edema and a large neck mass, traditional methods of securing the airway were not feasible. Initiation of femoral-femoral cardiopulmonary bypass, under local anesthesia, ensured adequate oxygenation and allowed a controlled tracheotomy to be performed. The result obtained suggests that this approach provides a safe solution for airway control when intubation or a surgically created airway is either unsuccessful or too hazardous.
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          The impossible airway: a plan.

          A patient presented with near complete airway obstruction due to a massive tumor. Nonsurgical methods failed to secure the airway, and surgical approaches were considered unlikely to succeed in a timely fashion. Cardiopulmonary bypass via femoral-femoral cannulation with the use of local anesthesia and a portable unit, followed by IV anesthesia, allowed the surgeons to perform a controlled tracheotomy.
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            Author and article information

            Affiliations
            Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center, Oklahoma, USA
            Author notes
            Address for correspondence: Dr. Himanshu Bhardwaj, Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center, P.O. Box 26901, WP1310, Oklahoma, OK 73190, USA. E-mail: himanshu.bhardwaj@ 123456ouhsc.edu
            Journal
            Lung India
            Lung India
            LI
            Lung India : Official Organ of Indian Chest Society
            Medknow Publications & Media Pvt Ltd (India )
            0970-2113
            0974-598X
            Jan-Feb 2017
            : 34
            : 1
            : 79-81
            5234205 LI-34-79 10.4103/0970-2113.197106
            Copyright: © 2017 Indian Chest Society

            This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

            Categories
            Case Report

            Respiratory medicine

            tracheal stenosis, cardio-pulmonary bypass, airway stenting

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