Apnoeic ventilation for shared airway surgery during the COVID-19 pandemic

Abstract

This report describes the care provided to a 64-year-old woman presenting with airway obstruction following recovery from COVID-19 pneumonitis, prolonged tracheal intubation and tracheostomy weaning. Her initial admission was with COVID-19 pneumonitis during the first surge of cases in early 2020, and was complicated by multiple bilateral segmental pulmonary emboli, a 28-day stay in intensive care, 16 days of mechanical ventilation and finally, a tracheostomy with subsequent weaning of respiratory support and rehabilitation. On presentation, her symptoms of airway obstruction were because of significant granuloma of the posterior glottis and subglottis, as well as a mild lambdoid deformity at the site of her previous tracheostomy. The key learning points described relate to the use of apnoeic oxygenation during the COVID-19 pandemic, managing the shared airway, as well as the management of post-intubation laryngotracheal complications.

Keywords: COVID‐19; airway obstruction; apnoeic oxygenation; jet ventilation.

Figure 1

(a) Endoscopic image of subglottic granulomata before excision, then (b) after excision. (c) Endoscopic appearance of posterior commissure at follow‐up microlaryngoscopy, 6 weeks later.