Emergency bedside fibreoptic bronchoscopy for mucus plug-related dynamic airway obstruction causing extreme hypercapnia in post-corrosive tracheal stenosis
Abstract
A woman in her 20s with tracheal stenosis following corrosive acid ingestion presented to the emergency department (ED) with acute respiratory failure 5 months after the initial injury, despite having a tracheostomy in situ. She had extreme hypercapnia (pCO2 198 mm Hg, pH 6.8) that persisted despite tracheostomy tube change and mechanical ventilation. Bedside flexible fibreoptic bronchoscopy revealed severe distal tracheal stenosis complicated by an adherent mucus plug creating a dynamic ball-valve obstruction. Ventilation improved only after clearance using an ultraslim 3.1 mm neonatal fibreoptic bronchoscope, with rapid normalisation of gas exchange within hours. This case highlights that dynamic mucus impaction in post-corrosive tracheal stenosis can cause immediately life-threatening but potentially reversible extreme hypercapnia and underscores the need for EDs managing complex airways to maintain ready access to paediatric and neonatal ultra-slim fibreoptic bronchoscopes.
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- The Matrisome: In Silico Definition and In Vivo Characterization by Proteomics of Normal and Tumor Extracellular Matrices
- The Escherichia coli MG1655 in silico metabolic genotype: Its definition, characteristics, and capabilities
- In silico pharmacology for drug discovery: methods for virtual ligand screening and profiling
- In silico prediction of splice-altering single nucleotide variants in the human genome
- In silico clinical trials: how computer simulation will transform the biomedical industry
- In silico optimization of a guava antimicrobial peptide enables combinatorial exploration for peptide design
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.