ABSTRACT : A case report of post intubation tracheal stenosis

METHODS : Perioperative management

RESULTS : Patient was managed well

CONCLUSIONS : Importance of endotracheal tube cuff pressure monitoring

ABSTRACT Endotracheal tube cuff pressure monitoring is commonly neglected in ICU’s.An intubated patient on prolonged ventilation with an endotracheal tube with a high cuff pressure may lead to tracheal stenosis. Here we are reporting a patient who developed post intubation tracheal stenosis. A 29 year old gentleman presented to out patient department with history of gradual onset of dyspnea and stridor of one week duration. From his past history we found that he was admitted in Medical ICU with a diagnosis of organophosphorus compound poisoning for which he was intubated and mechanically ventilated for 11 days. On investigating, CT and MRI scans of the neck showed tracheal stenosis measuring 3.5mm internal diameter of 1.7 cm length at C7-C8 level. It was diagnosed as post intubation tracheal stenosis and patient was posted for corrective surgery. In the operating room after induction and suxamethonium administration patient was intubated with pediatric rigid bronchoscope which was passed beyond the constriction and ventilated with jet ventilation. Meanwhile the surgeon proceeded with median sternotomy, exposed the stenosed part, excised it and did end to end anastomosis. After the anastomosis was completed patient was intubated with 7.5mm endotracheal tube positioning the cuff beyond the anastomosis. Patient was electively ventilated for one week in the recovery room with sedation and later extubated. We wanted to highlight the importance of endotracheal tube cuff pressure monitoring to avoid such complications.