Concomitant Intubation with Minimal Cuffed Tube and Rigid Bronchoscopy for Severe Tracheo-Carinal Obstruction

Abstract

Background: Our aim was to report on the use of an innovative technique for airway management utilizing a small diameter, short-cuffed, long orotracheal tube for assisting operative rigid bronchoscopy in critical airway obstruction.

Methods: We retrospectively reviewed the clinical data of 36 patients with life-threatening critical airway stenosis submitted for rigid bronchoscopy between January 2008 and July 2021. The supporting ventilatory tube, part of the Translaryngeal Tracheostomy KIT (Fantoni method), was utilized in tandem with the rigid bronchoscope during endoscopic airway reopening.

Results: Indications for collateral intubation were either tumors of the trachea with near-total airway obstruction (13), or tumors of the main carina with total obstruction of one main bronchus and possible contralateral involvement (23). Preliminary dilation was necessary before tube placement in only 2/13 patients with tracheal-obstructing tumors (15.4%). No postoperative complications were reported. There was one case of an intraoperative cuff tear, with no further technical problems.

Conclusions: In our experience, this innovative method proved to be safe, allowing for continuous airway control. It enabled anesthesia inhalation, use of neuromuscular blockage and reliable end-tidal CO₂ monitoring, along with protection of the distal airway from blood flooding. The shorter time of the procedure was due to the lack of need for pauses to ventilate the patient.

Keywords: airway; anesthesia; intubation; rigid bronchoscopy; tracheal stenosis.

Figure 1

The FOT was placed above the stenosis. (A) The rigid scope was inserted. With this view, the FOT was gently pushed below the stenosis and then cuffed. (B) At that moment, the airway tract above the cuff was excluded from the one below.

Figure 2

The same procedure as that shown in Figure 1A was performed. (A) Once the view showed the carinal obstruction and the tip of the FOT, the FOT was pushed toward the unobstructed site and the cuff was inflated at the level of the main patent bronchus. (B) At that moment, the healthy lung was excluded from the rest of the airway.

Figure 3

The figure shows a mid-trachea obstructive tumor leaving a very small airway lumen. (A) The FOT tube was passed already and cuffed below the stenosis. The upper airway was excluded from the distal airway below the cuff. The rigid bronchoscope was placed, and the operative phase could be started (B).