Definitive Airway Management in Sepsis-Related Airway Edema Following a Failed Intubation: An Anesthesia-Guided Approach to High-Risk Airway Management

Severe infection and sepsis can significantly alter airway anatomy through inflammation, edema, and tissue friability, complicating definitive airway management in critically ill patients. These challenges are further magnified in individuals with prior failed intubation or airway trauma, where the margin for error is narrow, and loss of a functioning airway can be catastrophic. We report the case of a critically ill patient with influenza A-associated acute hypoxic respiratory failure and septic shock. Our patient required definitive airway management in the setting of severe airway edema and prior failed intubation complicated by cardiac arrest. The patient arrived with an existing tracheal airway and extensive airway inflammation, which limited standard airway visualization. Due to the high risk of airway loss, a staged, anesthesia-led approach was employed. The main goal was to preserve the existing airway while escalating visualization techniques. The initial video laryngoscopy was not successful in earlier attempts due to diffuse airway edema. Therefore, alternative video laryngoscopy improved visualization and allowed for controlled fiberoptic bronchoscopy, enabling accurate positioning of the tube and confirmation. This case demonstrates the importance of preserving an existing airway and using staged visualization techniques when managing complex airways with severe infection and airway inflammation.