Cross-field airway management for distal postintubation stenosis: a case of successful reconstruction without ECMO support

BACKGROUND: Tracheal stenosis following intubation is a relatively rare but difficult condition. Some degree of airway injury is common following intubation, no matter whether it is prolonged or of short duration. CASE REPORT: Patient is a 54-year-old woman with a past medical history of severe traumatic brain injury (TBI) and intracerebral hemorrhage, for which she was admitted to the intensive care unit (ICU) for neuroprotection. She remained in the ICU for over two months with prolonged mechanical ventilation and tracheostomy. After full recovery, she developed wheezing and dyspnea. A postintubation tracheal stenosis was diagnosed near the bifurcation of the main bronchus, and surgery was needed. Primary resection and reconstruction were achieved using cross-field ventilation without ECMO through precise surgical planning, intermittent ventilation strategies, and judicious extubating criteria. DISCUSSION AND CONCLUSION: PTS is an iatrogenic lesion that has declined in incidence thanks to the development of new technology and strict surveillance. Nonetheless, it remains a troublesome complication of a critically ill patient that can severely hinder their recovery and quality of life; therefore, the medical team must remain vigilant at all times to prevent these potentially preventable complications.