Treating life-threatening airway compromise due to concurrent COPD and tracheomalacia using translaryngeal shared-airway microsurgery

We treated life-threatening tracheomalacia in a 76-year-old man with severe chronic obstructive pulmonary disease using translaryngeal shared-airway microsurgical techniques to enable tracheal stent placement. These techniques included suspension laryngoscopy, transnasal humidified rapid-insufflation ventilatory exchange using OptiFlow-THRIVE, flow-controlled ventilation using the TriTube™ and the Evone ventilator, and supraglottic jet ventilation. A smooth silicone tracheal stent was secured using the cervico-tracheal (Howard) suture. Total airflow rose from 4.28l/s preoperatively to 6.31l/s at 10 months. Forced vital capacity increased from 2.27l to 2.81l. The patient remains stable five years later and has the original stent in situ. This case emphasises the value of translaryngeal shared-airway microsurgery to safely manage patients with significant morbidity and life-threatening tracheal disease.