Background: Congenital and acquired upper airway obstruction in infants commonly manifests as an acute, potentially life-threatening condition or a slow and gradual deterioration and can be a challenge to the pediatric anesthesiologist. This case series reports the nonconventional use of pediatric airway exchange catheters emergent and short-term airway management and lung ventilation in neonates and infants with severe laryngotracheal stenosis.
Case series: After the approval of local Institutional Review Board, 11 consecutive patients presenting with severe laryngotracheal stenosis exceeding 70% were prospectively studied. Median (range) age and weight were 32 days (0-96) and 2.7 kg (2.1-3.4), respectively. Induction of anesthesia consisted of sevoflurane 5% in oxygen followed by sevoflurane 3% in an air/oxygen mixture (Fio2 = 0.5). Spontaneous ventilation was maintained in all patients. The trachea was intubated using an Airway Exchange Catheter with an inner diameter of 1.6 mm (Cook Airway Exchange Catheters, Cook Medical, Bloomington, IN). An Airway Exchange Catheter was inserted through the stenosis and manually assisted ventilation was confirmed using capnography. Median (range) ventilation duration was 28 minutes (12-61 mins). In one neonate, the Airway Exchange Catheter failed to ensure proper ventilation and an emergency tracheostomy was performed. Respiratory distress was likely due to a significant increase in airway resistance at the stenosis level or distal accumulation of secretions.
Conclusion: Airway exchange catheters represent a useful additional tool for short-term advanced airway management for both oxygenation and ventilation in neonates and infants presenting with severe laryngotracheal stenosis.