Post-Intubation Tracheal Necrosis in a Dog Following Mutidetector Computed Tomography (MDCT)
Post-intubation iatrogenic tracheal stenosis is well established in humans, cats and horses. It is attributed to overinflation of the endotracheal tube (ETT) cuff, prolonged intubation period, patient manipulations with tube repositioning without cuff deflation and chemical injury due to inappropriate ETT disinfection process. Mechanical compression leads to ischemia-associated mucosal necrosis.
This report describes a case of tracheal necrosis and reduction of the intraluminal tracheal diameter caused by an inflammatory process and accompanied by accumulation of necrotic material and fibrinous exudate in a 10-year-old, male, neutered, Labrador Retriever.
Ten days following general anesthesia for abdominal MDCT to investigate a splenic nodular lesion, the patient was admitted with severe tachypnea, dyspnea, inspiratory strider, fever and cyanosis. Complete blood cell count revealed moderate leukocytosis, whereas biochemical profile was unremarkable. Lateral thoracic radiographs demonstrated narrowing of the tracheal lumen with soft tissue opacity approximately 2–3 cm caudal to the hyoid apparatus. The larynx was evaluated prior intubation and found edematous due to labored breathing. Tracheoscopy yielded mucus plugs and necrotic material attached to the tracheal wall, endoscopically removed. Histology of the aberrant tissue identified organized areas of fibrin and neutrophilic inflammation.
Pressure or contact tracheal necrosis were presumed. The patient recovered uneventfully while placed in an oxygen cage. Therapeutic regime comprised of hydrocortisone sodium succinate (Solu-Cortef; Pfizer Hellas) at 8,5 mg/kg and ampicillin (Ampicillin; Cooper AE) at 15 mg/kg administered intravenously.
Although in literature the incidence of post-intubation complications in dogs is low, awareness should be raised regarding ETT size selection and disinfection processes.