Awake percutaneous tracheostomy as an alternative to open emergency tracheostomy in a threatened airway

Abstract

AbstractBackground: This case report details the management of a patient with a threatened airway booked for an emergency awake tracheostomy but successfully managed with a percutaneous tracheostomy technique. The case illustrates the challenges of managing a severely compromised airway and presents an alternative technique for consideration that may obviate the requirement for a challenging surgical attempt to secure the airway.Methods: A 42-year-old male presented with a threatened airway as a consequence of complicated dental sepsis extending into the neck. Extensive head and neck swelling was assessed as severe enough to make bag-mask ventilation, direct laryngoscopy and rescue with a supraglottic airway (SGA) impossible. Critical narrowing of the pharynx, identified on CT scan, made fibre-optic intubation risky in terms of completely obstructing the airway during the attempt. The airway was secured by a percutaneous tracheostomy technique with local anaesthetic under ultrasound guidance with the pati...