Signalement and history: A 9-year-old intact male Yorkshire Terrier, weighting 2.9 kg, suffered from severe respiratory distress due to tracheal collapse grade III and acute decompensation due to additional pneumonia. Supplemental oxygen (oxygen-cage with 50% fraction of inspired oxygen) did not improve blood oxygen saturation (SpO2 70%). An emergency intervention to temporarily bypass the upper airway obstruction in order to provide supplemental oxygen was essential. A naso-tracheal oxygen tube was not considered due to the small size of the dog. Endotracheal intubation was dismissed to avoid anesthesia and subsequent risk of requiring mechanical ventilation afterwards.

Description of the technique: Placement of a percutaneous intratracheal oxygen catheter under light sedation was performed. Intravenous butorphanol (0.3 mg/kg) for sedation and lidocaine (0.5 ml) for local analgesia were administered. The dog was in sternal recumbency, with the neck extended. Oxygen was provided via face mask. The trachea was palpated and a 0.5 cm transverse incision through the skin was performed, at 1 cm distal to the larynx. Through the incision, a 20 Ga needle was introduced between the 2nd and 3rd tracheal ring. A guide-wire was advanced 10 cm into the tracheal lumen. The needle was removed and the tissue dilator was carefully forwarded over the wire into the distal trachea. The dilator was removed again and a central venous catheter (7 Fr, 16 cm) was carefully forwarded over the wire 8 cm into the distal trachea. The wire was removed, and an oxygen source was immediately connected to the catheter. The catheter was sutured to the skin, and a light bandage was applied. This technique allowed a stabilization by direct delivery of oxygen into the catheter while bypassing the collapse. Pulse oximetry revealed a SpO2 higher than 96% after the procedure, and until the patient underwent tracheal stent placement on the following day.

Discussion: Placement of a central venous catheter into the trachea under local anesthesia and sedation only, is a minimally invasive technique to bypass a tracheal collapse when endotracheal intubation is not possible, and to directly deliver oxygen until a definitive therapeutic procedure can be performed.