Emergency percutaneous tracheostomy in two cancer patients with difficult airway: An alternative to cricothyroidotomy?
A 62-year-old male who was a known case of carcinoma right bronchus stage IV with bone and brain metastasis was admitted with left-sided chest pain, progressively increasing breathlessness since 4 hours. On examination, he was drowsy, hypoxemic on room air (SpO2 88%, PaO2- 64 mm Hg on FiO2- 0.6), with decreased air entry and tympanic node on percussion on left side of the thorax. Chest X-ray revealed left-sided pneumothorax, and 28 Fr intercostal drain was immediately placed. There was transient improvement in SpO2 and respiratory acidosis. After 1 hour, he had generalized tonic clonic seizure, for which lorazepam was given, and he was started on bag and mask ventilation.\nThe decision to secure definitive airway was taken in view of an altered mental status with persistent respiratory failure. Orotracheal intubation was tried; however, it failed due to restricted mouth opening and restricted lower jaw movement, with Cormack and Lehane grade III on direct laryngoscopy. The decision for emergency PCT was then taken and performed by Ciaglia technique using Blue Rhino PCT kit with 7.5 tracheostomy tube. Procedure was completed in less than 3 minutes. The tube position was confirmed with capnography []. In spite of obtaining definitive airway and using all aggressive medical measures, patient failed to show any clinical improvement and died of refractory shock after 4 days of ICU stay.