B53-05 When Stable Isn’t Safe: Prophylactic Intubation in Anticipation of Airway Compromise

Abstract Introduction Endotracheal intubation is used to facilitate ventilation and oxygenation, and is performed in cases of respiratory failure or airway protection. A "difficult airway" refers to a situation where a practitioner anticipates challenges with intubation. Prophylactic endotracheal intubation is the elective placement of an endotracheal tube in anticipation of a high risk of airway compromise. In this case, we present an example of the management and recognition of a difficult airway, along with prophylactic intubation. Case Description A 62-year-old female with a medical history of rheumatic heart disease, type 2 diabetes mellitus presented to the emergency room with a sore throat, dysphagia, and swelling on the right side of her neck. The patient was unable to eat or drink due to pain. Physical examination showed coarse upper respiratory sounds, no stridor, and normal oxygen levels on room air. The midline uvula appeared edematous. A CT scan of the neck showed a cystic lesion centered in the lingual tonsil and the dorsal base of the tongue, raising concerns about a possible tonsillar abscess. The scan also revealed diffuse mucosal edema throughout the oropharynx, supraglottic area, and epiglottis. Due to concerns regarding a potentially difficult airway and the risk of complications, a multidisciplinary team of intensivists and otolaryngologists decided to proceed with prophylactic intubation. The patient was taken to the operating room, where intubation proved difficult because of challenges in obtaining a clear view, along with the rupture of the abscess. She was subsequently treated with steroids and antibiotics, followed by surgical drainage. The patient was later extubated and made a successful recovery. Discussion Endotracheal intubation involves inserting a tube through the mouth or nose into the trachea to secure the airway, facilitate ventilation, and oxygenation. A "difficult airway" refers to a situation in which a practitioner anticipates or challenges with tracheal intubation or the use of a supraglottic airway, or recognizes the need for an emergency surgical airway. Prophylactic endotracheal intubation is the elective placement of an endotracheal tube in anticipation of a high risk of airway compromise. This case presents an example of prophylactic intubation for a patient at high risk of developing respiratory distress, despite presenting in a stable condition. Clinical decision-making is essential to recognize the potential for further respiratory failure and complications. A proactive approach tailored to the patient's overall presentation can be a lifesaving measure and help avoid complications in the event of clinical deterioration. This abstract is funded by: None