Anestéziológia a intenzívna medicína 2/2022

Expiratory central airway collapse (ECAC) is frequent unrecognized cause of respiratory insufficiency

Expiratory central airway collapse (ECAC) is often an unrecognized cause of respiratory failure of patient. ECAC describes two different pathofysiologic condition tracheobronchomalacia (TBM) a excessive dynamic airway collapse (EDAC). The malacia or weakness of cartilage that supports the tracheobronchial tree may occur only in the trachea (tracheomalacia) or in both the trachea and bronchi (TBM). On the other hand EDAC is characterized by airway compromise because of bulging posterior membrane into the airway lumen with intact cartilage. Clinical symptoms in both conditions are very similar and they are caused by airway obstruction. Some patients are asymptomatic, other may present with severe dyspnea, intractable cough, wheezing, recurrent infections and respiratory failure. Often these findings lead to the misdiagnosis of asthma or chronic obstructive pulmonary disease. The autors present a case report of a 71-years old man with severe clinical manifestation of excessive dynamic airway collapse. Given the persistence of dependence on artificial lung ventilation, he was indicated for surgical treatment with VV-ECMO support.

Keywords: expiratory central airway collapse, excessive dynamic airway collapse, tracheobronchomalacia, tracheobronchoplasty, respiratory failure