Thread by @dastrainees

#JanuAIRWAY Day 22. Airway Obstruction – Infraglottic (intrathoracic). Again, presents its own set of challenges. Let’s dive in … Here's a #OnePager (Ft. expert contribution Sadie Khwaja @ENT_UK )
#JanuAIRWAY 1/7

Issues:
- Upper/Mid lesions usually low risk – ETT may pass beyond
- Low tracheal/Bronchial lesions = high risk, best managed in specialist centres
- CT scan = essential
- Sudden obstruction can occur at ANY time
- Potential compression of heart/vessels
#JanuAIRWAY 2/7

Severe Obstruction:
- Check position patient breaths best in
- Spont vent may help, IPPV may cause airway collapse
- Opinion re: IV vs inhalational = mixed
- Ketamine ?preserves chest wall tone
- Need back up plan
- Consider Heliox/bypass/ECMO before starting
#JanuAIRWAY 3/7

Potential rescue manoeuvres:
In an emergency – consider passing an ETT tube & then placing a jet catheter (e.g. Cook or Aintree) beyond obstruction.
Alternatively, an extra-long ETT can be created by cutting reinforced ETT & inserting into the free end of another
#JanuAIRWAY 4/7

Options:
- ATI/AFOI – view level of obstruction & try to pass ETT beyond before induction
- Rigid bronchoscope
- Jet vent.
- Cardiopulmonary bypass as ‘standby’ technique is often impractical - if you think you need it, need to be in a cardiothoracic theatre
#JanuAIRWAY 5/7

Here are some papers / links that you might find interesting:
🔗atsjournals.org/doi/full/10.15…
🔗bmcresnotes.biomedcentral.com/articles/10.11…
🔗jtd.amegroups.com/article/view/1… 🔗ncbi.nlm.nih.gov/pmc/articles/P…
🔗pubs.asahq.org/anesthesiology…
🔗academic.oup.com/bjaed/article/…
#JanuAIRWAY 6/7

Hope that helps. Tomorrow we'll look at Malacias; SVC Obstruction; and Bleeding & Airways. See you then! #JanuAIRWAY 7/7

*Disclaimer: Inclusion of content (equipment, techniques and scoring systems etc.) in #JanuAIRWAY does not constitute DAS endorsement