Usefulness of Tube Exchanger for Reintubation During Bronchial Foreign Body Removal with Laryngeal Edema

Abstract

Background. When the dimensional constraints of an endotracheal tube preclude the passage of an airway foreign body, the conventional strategies are (i) en bloc withdrawal of the foreign body together with the tube or (ii) tracheostomy when upper-airway obstruction is present. However, tracheostomy is contraindicated in cases of anterior cervical infection. Case Presentation. A 76-year-old man aspirated a dental prosthesis that perforated the hypopharyngeal wall and caused a deep pharyngeal abscess. The second denture was subsequently aspirated and became impacted in the left basal bronchus. Progressive hypopharyngeal inflammation resulted in severe laryngeal edema, necessitating endotracheal intubation to protect the airway. Flexible bronchoscopy confirmed the lodged prosthesis, however attempts at extraction with a standard forceps were unsuccessful because the object could not traverse the internal lumen of the tube. En bloc removal of the tube and foreign body was associated with an unacceptable risk of failed re-intubation due to the laryngeal edema, whereas tracheostomy posed a risk of exacerbating the patient's cervical infection. Consequently, a tube exchanger^® (TE) was employed. After ensnaring the prosthesis in a recovery net, the bronchoscope was withdrawn, the TE was advanced through the endotracheal tube, and the tube together with the net-encased prosthesis was extracted as a unit. A new endotracheal tube was then railroaded over the indwelling TE, re-establishing a secure airway. Conclusion. In cases where upper-airway obstruction coexists with contraindications to tracheostomy, TE-assisted retrieval represents a feasible alternative for removing foreign bodies that cannot pass through an endotracheal tube and for maintaining airway control during the procedure.