Subglottic Tracheal Edema Associated with Intubation Using a Double-Lumen Intratracheal Tube

Naoki Kanauchi ¹, Hikaru Watanabe ², Isamu Watanabe ³

¹ Nihonkai General Hospital, Sakata, Japan; ² NIhonkai Genaeral Hospital, Sakata, Japan; ³ Nihonkai Genaeral Hospital, Sakata, Japan;

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – B

Abstract

Background: Subglottic tracheal edema is a potentially life-threatening complication associated with tracheal intubation. Prompt airway management, including a tracheotomy, is required for treatment. The aim of this study was to assess the risk of subglottic tracheal edema associated with intubation using a double-lumen intratracheal tube and the results of treatment.

Methods: We treated 6 patients who had subglottic tracheal edema after extubation with double-lumen intratracheal tubes after undergoing lung cancer surgery in our hospital between 2008 and 2016. We retrospectively collected related clinical information and treatment from chart reviews.

Results: There were 6 patients (0.9% of all patients who underwent lung cancer surgery) with subglottic tracheal edema identified (all females). All patients had undergone anatomical pulmonary resection during which a double-lumen endobronchial tube (tube diameter, 32 - 35 Fr) was inserted into the trachea. The median age was 75 years (range, 64-89 years). The tracheas tended to be narrower than the average for Japanese (10.89 mm vs. 14 mm). All patients presented with inspiratory stridor and difficulty breathing between 24 and 48 h after extubation. Bronchoscopy was performed to diagnose subglottic tracheal edema. Emergency tracheotomies were performed in 4 patients, and 2 patients were treated conservatively with steroids. All patients recovered within 1 week and were discharged from the hospital without sequelae.

Conclusion: We managed 6 patients with subglottic tracheal edema. The patients were all females, and their tracheas were narrower than the average for Japanese. Subglottic tracheal edema is a temporary, life-threatening condition. Adequate airway management is critical to maintaining airway patency in patients with subglottic tracheal edema.