Nebulized Saline to Manage Airway Secretions in a Prone Pediatric Patient: A Case Report

A 10-year-old female with a history of a complete C2 fracture, tracheostomy, and ventilator dependence, presented for a T2 to pelvis posterior spinal fusion. She encountered airway obstruction causing rising end-tidal CO₂ (ETCO₂), mild oxygen desaturation, and increased peak inspiratory pressures to obtain adequate tidal volumes. Airway suctioning was not successful. A fiberoptic scope was utilized to assess the obstruction and check the position of the endotracheal tube, revealing hard secretions that were resistant to removal. A vibrating mesh nebulizer (VMN), which was already connected to the anesthesia circuit from an albuterol treatment administered to the patient shortly after intubation, was used to administer 2 cc of normal saline. The nebulized saline successfully loosened the thick secretions enough to enable suctioning of the mucous plug. The ETCO₂ and ventilation parameters normalized after intervention. This case illustrates the benefits of the fine mist generated by a VMN using only saline in managing airway secretion buildup unable to be cleared by conventional means.