Excessive Dynamic Airway Collapse: An Unexpected Contributor to Respiratory Failure in a Surgical PatientReport as inadecuate




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Case Reports in Anesthesiology - Volume 2015 2015, Article ID 596857, 5 pages -

Case ReportDepartment of Anesthesiology, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, Columbus, OH 43210, USA

Received 1 May 2015; Accepted 27 May 2015

Academic Editor: Maria Jose C. Carmona

Copyright © 2015 Michael R. Lyaker et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Central airway collapse plays a significant, underrecognized role in respiratory failure after extubation of critically ill patients. Historically, airway collapse has been attributed to tracheomalacia TM, softening of the cartilage in the trachea and other large airways. More recently, excessive dynamic airway collapse EDAC has been described as a distinct process unrelated to a loss of cartilaginous airway support. EDAC is caused by the posterior wall of the trachea bulging forward and causing airway obstruction during exhalation. This process is exaggerated when intrathoracic pressure is increased and results in a clinical picture of coughing, difficulty clearing secretions, dyspnea, and stridor. The increased use of computerized tomography and fiberoptic bronchoscopy has identified varying degrees of EDAC and TM in both symptomatic and asymptomatic individuals. This has led to renewed consideration of airway collapse and the different processes that contribute to it. Here we describe a 43-year-old morbidly obese patient who failed repeated attempts at extubation after elective hysterectomy. We will discuss the processes of EDAC and TM, describe how this condition contributed to this patient’s respiratory failure, and review diagnosis and management options.





Author: Michael R. Lyaker, Victor R. Davila, and Thomas J. Papadimos

Source: https://www.hindawi.com/



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