Acute life-threatening massive haemoptysis in a patient with a predicted difficult airway and emphysematous lung disease

Acute life-threatening massive haemoptysis in a patient with a predicted difficult airway and emphysematous lung disease

Published: 29 Oct 2018

© Anaesthesia Cases / 2018-0155 / ISSN 2396-8397

Authors

Dr Amit Adlakha [1]
Dr Ifor Capel [2]
Dr Dinseh Addala [2]
Dr Peyton Davis [3]
Dr Adrian Wong [3]
  • [1] Specialist Registrar, Adult Intensive Care Unit, John Radcliffe Hospital, Oxford, United Kingdom
  • [2] Specialist Registrar, Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
  • [3] Consultant, Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

Summary

A 61-year-old male presented to the emergency department with acute life-threatening massive haemoptysis. His previous history was remarkable for extensive mandibular and retromolar resection and reconstruction for squamous cell carcinoma ten years previously. A recent computed tomography scan of the thorax showed severe bullous emphysema. There were several features suggestive of a difficult airway, such as reduced mouth opening and fixed neck flexion. A technique was required, therefore, that avoided the use of a double-lumen tube or bronchial blocker.

We report the successful use of a post-carinal Aintree intubation catheter to facilitate oxygenation of the right lung with a concurrent bronchially-advanced single-lumen tracheal tube to isolate and ventilate the left lung. This temporising strategy successfully bridged the life-threatening phase of acute haemoptysis and the patient later received definitive treatment for a newly-identified right upper lobe adenocarcinoma.

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