Severe Subglottic Tracheal Stenosis Dictates Intercontinental Transfer of a 2-Year-Old Child with Tracheostomy Tube In Situ

Abstract

Atrioventricular septal defect (AVSD) is the most common congenital cardiac anomaly associated with Down’s syndrome. Children with AVSD develop pulmonary arterial hypertension and often require extensive therapy with pulmonary vasodilators in the postoperative period. The postoperative management is complicated by prolonged mechanical ventilation through endotracheal tube or tracheostomy tube. This artificial airway may trigger various airway complications including subglottic tracheal stenosis. The incidence and severity of subglottic tracheal stenosis is high in children with congenital syndromes. Inability to extubate or decannulate trachea and rapid respiratory compromise while attempting to do so directs toward a diagnosis of subglottic tracheal stenosis. The following case report discusses a 2–year-old boy from Nigeria who was discharged with tracheostomy tube in situ due to severe subglottic tracheal stenosis and surgical tracheoplasty could not be done at his present age. The implications of prolonged tracheostomy tube in situ and the hazards thereof during transfer of the child are being described.

Tracheal anomalies associated with Down syndrome: A systematic review

“…In the studied population, acquired tracheal stenosis accounted for 6% of children with laryngotracheal airway pathology. Acquired tracheal stenosis is generally caused by intubation with an oversized tube or prolonged intubation 18 . Selecting an appropriately sized endotracheal tube is, therefore, important.…”