ABSTRACT: CHALLENGES IN EXTUBATING A COPD PATIENT WITH RESPIRATORY FAILURE AND ASYMPTOMATIC LONG STANDING MULTINODULAR GOITRE WITH RETROSTERNAL EXTENSION

80 years old female,known Diabetic, Hypertensive, COPD, with thyroid swelling for 40 years presented with history of Generalised Tonic Clonic seizures She was conscious but drowsy,tachycardic, elevated blood pressure and crackles present. Patient deteriorated within 2 hours requiring mechanical ventilation in view of low GCS.ABG showed type II respiratory failure. CT brain plain was normal and neurologist opined seizure episodes could be due to cerebral hypoxia. The patient improved clinically and weaned off from the ventilator.

Post extubation patient developed stridor, managed with adrenaline nebulisation, hydrocortisone& NIV. The patient was reintubated and connected to ventilator since there was no clinical improvement.

CTscan neck showedthyroid mass compressing over hypopharynx and larynx with mild retrosternal extension. Surgical opinion obtained and planned for Total thyroidectomy with or without sternotomy. Pulmonologist opined type 2 respiratory failure & plan to extubate after surgery.

Total thyroidectomy was done under GA with controlled ventilation.Intra operative period was uneventful and managed postoperatively with steroids and elective ventilation in view of long standing thyroid swelling.Using airway exchange catheter, the patient was extubated the next day and was stable

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