Use of a laryngeal mask airway to stop a supraglottic air leak which prevented adequate ventilation via a tracheostomy in a patient with cerebral palsy and pneumonia

Abstract

We report an adolescent developing ventilation failure due to supraglottic air leakage with the use of an uncuffed hand-made tracheal tube fit to her tracheobronchial deformity. To eliminate the supraglottic air leakage, a size 2.5 laryngeal mask airway (LMA) was inserted into the oral pharynx. Most of air leakage arose from the LMA. Supraglottic air leakage was not detected under mandatory mechanical ventilation following sealing of the 15-mm connector of the LMA with a piece of tape, and the respiratory condition of the patient gradually improved. The combination of a hand-made Y-shaped tube and the LMA was useful in restoring adequate ventilation. In conditions where air leaks through the glottis during mechanical ventilation interfere with adequate ventilation or the maintenance of airway pressure, the use of an LMA may be adequate to stop or significantly decrease the leak.

Elective use of an uncuffed small-bore cricothyrotomy tube with balloon occlusion of the subglottic airway

“…[22][23][24] In our experience, once the MT is placed, it is beneficial to use an SGA with occlusion of the 15-mm connector until insertion of the surgical laryngoscope. Simpler methods, including manual occlusion of the patient's nose and mouth and neck flexion without head extension also facilitated ventilation via the MT.…”