Journal of Anaesthesia & Critical Care Case Reports

Vol 5 | Issue 1 | Jan-April 2019 | page: 9-10 | Meghena Mathew, Nagarajan Ramakrishnan, Ashwin K Mani

Authors: Meghena Mathew [1], Nagarajan Ramakrishnan [1], Ashwin K Mani [1].

[1] Department of critical care medicine

Address of Correspondence

Dr. Ashwin K Mani,
Department of critical care medicine,
Apollo First Med Hospital, Chennai.
Email: ashwin.mani@gmail.com

Abstract

Introduction: We present a rare cause of chronic hypercapnic respiratory failure due to bilateral vocal cord palsy. Identification of chronic bilateral vocal cord palsy as a cause for respiratory failure in an intensive care unit (ICU) can be challenging and the treatment may warrant not only mechanical ventilation but tracheostomy.
Case presentation: A 70-year-old lady presented to us with worsening dyspnea of 10 days duration and stridor of 34 years duration. She had a history of childhood diphtheria. She failed non-invasive ventilation (NIV) for type-2 respiratory failure and required early tracheostomy. Her respiratory failure and clinical condition remarkably improved post tracheostomy. Flexible laryngoscopy showed bilateral vocal cord palsy.
Conclusion: Differentiating the upper airway pathology from obstructive diseases of the lower airway as cause for chronic respiratory failure is essential in a critical care unit, as NIV may not be of any benefit in the former. This case report highlights the importance of considering upper airway disease causing chronic respiratory failure which would require a different clinical management including early intubation with tracheostomy.
Keywords: respiratory failure, vocal cord palsy

References

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