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Pediatrics |

Severe Lordoscoliosis Causing Mechanical Airway Compression FREE TO VIEW

Merrick Lopez, MD; Shyam Kishan, MD; Thomas Bahk, MD; Mudit Mathur, MD
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Loma Linda University Medical Center, Loma Linda, CA


Chest. 2014;145(3_MeetingAbstracts):436A. doi:10.1378/chest.1836445
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Abstract

SESSION TITLE: Congenital Disorder Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Mechanical airway compression from thoracic bony abnormalities is a rare cause of tracheobronchial obstruction in children and may lead to problems in the operating room or intensive care unit when extubation is attempted. We present a case of a 13-year-old male with Duchenne muscular dystrophy who was admitted to the pediatric intensive care unit(PICU) after resuscitation following an 8-minute cardiopulmonary arrest from airway obstruction.

CASE PRESENTATION: Our patient presented to an outside facility with cough. He went into cardiopulmonary arrest after apparently aspirating his secretions. On admission to the PICU he was noted to be alert and responsive and was subsequently extubated. He failed extubation immediately from respiratory failure and was reintubated. On hospital day 7 he also had an acute decompensation while intubated where he could not be ventilated despite replacement of the endotracheal tube(ETT). Ventilation only seemed to be restored with firm chest compressions during resuscitation. Flexible and rigid bronchoscopies demonstrated flattening of the distal trachea and both mainstem bronchi. Computed tomography(CT) of the chest suggested that the tracheal compression was likely secondary to his narrow AP diameter and thoracic spine lordosis. He had surgery on hospital day 21 to repair his severe lordoscoliosis. Using bronchoscopic guidance, anesthesia placed a double-lumen ETT to cannulate the left mainstem bronchus to ensure airway patency during surgery. A follow up bronchoscopy on post-op day 4 showed no residual airway narrowing when the double-lumen ETT was replaced with a standard ETT. He was extubated to room air on post-op day 8 and remained stable on room air for the remainder of the hospitalization.

DISCUSSION: Although thoracic bony abnormalities are rare causes of airway compression, they should be considered in patients with neuromuscular disease. Bronchscopy and CT scan can aid in diagnosis.

CONCLUSIONS: This case illustrates the potential for severe mechanical airway compression from thoracic bony abnormalities in children with neuromuscular disorders. Surgical correction of the spine can dramatically alleviate respiratory compromise as well as improve the quality life of these patients.

Reference #1: Alotaibi S, Harder J, Spier S. Bronchial obstruction secondary to idiopathic scoliosis in a child: a case report. Journal of medical case reports. 2008;2:171.

Reference #2: Rittoo DB, Morris P. Tracheal occlusion in the prone position in an intubated patient with Duchenne muscular dystrophy. Anaesthesia. Aug 1995;50(8):719-721.

Reference #3: Andrews TM, Myer CM, 3rd, Gray SP. Abnormalities of the bony thorax causing tracheobronchial compression. International journal of pediatric otorhinolaryngology. Jun 1990;19(2):139-144.

DISCLOSURE: The following authors have nothing to disclose: Merrick Lopez, Shyam Kishan, Thomas Bahk, Mudit Mathur

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