Background: Complete airway obstruction is a fatal condition during removal of an airway foreign body. Although extracorporeal membrane oxygenation (ECMO) is often used, ECMO has a risk of complications including bleeding. We report a case in which one-lung jet ventilation (JV) was successfully used to maintain oxygenation during removal of a migrated bronchial stent.
Case report: A 55-year-old woman (height, 160 cm; weight, 54 kg) underwent bronchial stenting to a stenotic left main bronchus (Fig. 1a), and mechanical ventilation via tracheostomy was continued due to post-tuberculosis sequelae. Three months after the stenting, the bronchial stent had proximally migrated to the trachea and complete airway obstruction was likely to occur (Fig. 1b); therefore, stent removal using rigid bronchoscopy was scheduled under general anesthesia. General anesthesia was induced and maintained with propofol and remifentanil. We prepared ECMO on stand-by and oral intubation with an endotracheal tube was performed after the removal of the tracheostomy tube. An airway exchange catheter (AEC) (OD, 3.7 mm) (Cook🄬, Bloomington, USA) was advanced to the right main bronchus by passing it through the outside of the endotracheal tube under bronchoscope monitoring (Fig. 1c). One-lung JV through the AEC was then started. Since PaO2 was maintained at 95 mmHg after one-lung JV had been started (FiO2, 1.0; inspiratory time, 0.5-1.0 sec; respiratory rate, 15/min; oxygen pressure, 0.2 MPa), we removed the endotracheal tube and inserted a rigid bronchoscope. The bronchial stent was removed uneventfully under one-lung JV (Fig. 1d) and SpO2 was maintained at 99-100% during the procedure. The patient emerged from anesthesia without complications.
Discussion and Learning Points: In this case, a long and thin AEC was a suitable airway device and oxygenation was maintained by one-lung JV. Although JV has the potential to cause barotrauma, the incidence of the complication is relatively low in a non-emergency setting1); therefore, one-lung JV with an AEC is considered to be a valuable technique for airway management of distally located airway stenosis.

01 / Efficacy of one-lung jet ventilation using an airway exchange catheter for removal of a migrated bronchial stent: a case report