Respiratory insufficiency and dynamic hyperinflation after rigid bronchoscopy in a patient with relapsing polychondritis -a case report-

Abstract

Relapsing polychondritis (RP) is an uncommon disease that is characterized by inflammation and destruction of cartilaginous structures. When tracheobronchial tree is involved, respiratory obstructive symptoms can occur. A 35-year-old man, with a previous diagnosis of RP, was scheduled for rigid bronchoscopy to relieve dyspnea, caused by subglottic stenosis. After laser splitting of the subglottic web, the spontaneous respiration of the patient was insufficient, and hypercarbia developed progressively even with assisted ventilation. After 20 minutes of aggressive hyperventilation to reduce end-tidal CO2 level, sudden extreme tachycardia and hypotension developed. Ventilation rate was reduced and prolonged expiration time was allowed to alleviate a near-tampon status from dynamic hyperinflation. After the hemodynamic status was stabilized, the patient was transferred to the ICU for mechanical ventilation. He received ICU care for 30 days, and now, he was on supportive care on a ward, considering Y stent insertion to prevent luminal collapse from tracheobronchomalacia.

Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report

“…When general anesthesia is necessary, cautious airway management is needed [ 11 ], or an oxygen supply should be guaranteed by extracorporeal membrane oxygenation [ 12 ]. During general anesthesia, respiratory insufficiency associated with dynamic hyperinflation or difficult extubation have been reported [ 13 , 14 ]. Respiratory problems are the main concern in the anesthetic management of RP patients.…”

Relapsing Polychondritis Misdiagnosed and Treated as a ''Soft Tissue Infection'' and a Brief Review of Diagnostic Clinical Clues

“…23 Costochondritis, ocular inflammation manifested as conjunctivitis, iritis, scleritis, retinopathy, even retinal detachment, and polyarthritis affecting frequently interphalangeal joints and knees have also been reported. 20,[22][23][24] Early stages of large airway and heart disease may be insidious. Therefore extra attention must be paid to the examination of these systems when RPC is included in the differential diagnosis.…”