Mechanical test lung and artificial trachea simulations may provide useful information on the interaction of HFOV with altered lung mechanics and may contribute to the formulation of HFOV clinical strategies. Important limitations of these models include absence of gas exchange, histologic and biologic markers, or hemodynamic data.
Tracheomalacia and tracheobronchomalacia are rare disorders of a weakened airway that predispose patients to excessive airway compression, typically during expiration. Recommended anaesthetic management includes continuous positive airways pressure or positive end-expiratory pressure in order to maintain airway calibre. We present the case of a 57-year-old female with Weill-Marchesani syndrome, tracheobronchomalacia, and a permanent tracheostomy in whom we experienced difficulty maintaining adequate ventilation, oxygenation, and tidal volumes with positive pressure ventilation during anaesthetic induction, which improved with restoration of spontaneous breathing. We liken this to the physiology of an anterior mediastinal mass and recommend a similar anaesthetic approach.
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