Frequently, when we consider airway maintenance, we think of removing fluids and harmful substances from the trachea, but what happens when the trachea itself is part of the problem?
Airway stenosis (also called tracheal stenosis) is a narrowing of the trachea that makes breathing, speech and swallowing difficult. The causes for this condition are many, but no matter how a patient develops airway stenosis, it can contribute to respiratory troubles that result in an emergency and potentially require suctioning. However, with a damaged, narrow airway, responders will need to take extra care to avoid further challenges.
Read on for a breakdown of airway stenosis and how to approach suctioning for those with this condition.
Causes
While sometimes people can be born with airway stenosis, many cases are caused by an accident, illness or procedure that damages the airway. These include:
- Long-term intubation
- Tracheostomy
- Injuries to the throat or chest
- Viral or bacterial infections
- Autoimmune disorders
- Tumors pressing against the trachea
- Ingesting caustic or corrosive substances
- Acid reflux
Symptoms
Airway stenosis can present itself in a similar manner to other respiratory conditions, or it can cause or intensify current respiratory diseases. This can make it difficult to recognize, unless the patient or a family member is aware the condition exists. A thorough patient assessment may reveal stenosis to a responder, but these are some other symptoms commonly found with the condition:
- Shortness of breath/easily winded
- Apnea
- Wheezing or another form of noisy breathing
- Eating or swallowing issues
- Frequent pneumonia or upper respiratory infections (patients may not be able to cough up mucus, leading to reinfection)
Suctioning complications and treatment
As a narrowing of the trachea, sometimes featuring sensitive scar tissue, airway stenosis presents challenges for airway management, particularly suctioning and intubation. In fact, as we’ve discussed, prolonged intubation can even cause the condition. This means responders who are trying to manage a more difficult airway will need to approach treatment with an extra level of caution.
- Patient assessment: Before beginning any suctioning, providers should ensure equipment is functioning and any potentially necessary accessories are near at-hand; the patient must be immobilized and in position to allow for access to the trachea; providers must examine the mouth and visible areas for blood or tissue; and providers should listen for unusual sounds that indicate an obstruction and assess the patient’s chest rise.
- Catheter selection: When using suctioning to prepare for an intubation, the best practice is for the suction catheter to be less than 50 percent of the internal diameter of the endotracheal tube. Obviously, depending on the size of the patient that size may vary, so providers should invest in multiple sizes. Airway stenosis, however, necessitates a smaller catheter than normal — this is common in geriatric patients, especially.
- Suction power: As with catheter size, the suctioning power level may change depending on the patient’s age, size and condition. For example, children and geriatric patients tend to have weaker, more delicate airways and require less power than a provider may use in the average adult patient. Additionally, providers should suction for no longer than 10 seconds at a time.
Airway stenosis is a unique form of tracheal trauma, but with careful attention — and the right equipment — responders can provide effective suctioning while maintaining patient safety. At SSCOR we have a range of products specifically designed for hospital and EMS use, as well as disposable products, to assist providers in suctioning patients of all kinds. And don’t forget to check out the rest of our blogs for more helpful tips and educational information.
