Severe Tracheal Stenosis with Stridor: An Uncommon Complication of Prolonged Ventilation

Abstract

Post intubation (PI) and post tracheostomy (PT) tracheal stenosis are common among patients requiring prolonged ventilation. However, patients presented with symptomatic severe tracheal stenosis are rare. We report a middle aged man presented to us with a left basal ganglia bleeding secondary to hypertensive emergency with an initial Glasgow Coma Scale (GCS) of E2V5M5 (11/15). He was intubated for surgical aspiration of hematoma in the operating theatre and was sent to the Intensive Care Unit (ICU) for weaning. His stay was complicated with restlessness and aspiration pneumonia. A percutaneous tracheostomy was done in the ICU at day seven of hospitalization. After one week, the tracheostomy tube dislodged and developed noisy breathing; however patient was not tachypneic nor distress. An urgent Computed Tomography (CT) Thorax showed narrowing of trachea at level of thoracic inlet – sternoclavicular junction. An emergency tracheostomy and examination under anaesthesia was planned by the Otorhinolaryngology (ORL) team. Direct laryngoscopy showed one centimeter stenotic lesion with matured scar and granulations above the new tracheostomy site. The entire procedure was uneventful. We highlight (1) the importance of ETT cuff pressure monitoring, (2) urgent definitive management of impending total airway obstruction and (3) uncommon presentation of symptomatic severe tracheal stenosis.