Nebulized Saline to Manage Airway Secretions in a Prone Pediatric Patient: A Case Report.

A 10-year-old female with a history of a complete C2 fracture, tracheostomy, and ventilator dependence, presented for a T2 to pelvis posterior spinal fusion. She encountered airway obstruction causing rising end-tidal CO2 (ETCO2), mild oxygen desaturation, and increased peak inspiratory pressures to obtain adequate tidal volumes. Airway suctioning was not successful. A fiberoptic scope was utilized to assess the obstruction and check the position of the endotracheal tube, revealing hard secretions that were resistant to removal. A vibrating mesh nebulizer (VMN), which was already connected to the anesthesia circuit from an albuterol treatment administered to the patient shortly after intubation, was used to administer 2 cc of normal saline. The nebulized saline successfully loosened the thick secretions enough to enable suctioning of the mucous plug. The ETCO2 and ventilation parameters normalized after intervention. This case illustrates the benefits of the fine mist generated by a VMN using only saline in managing airway secretion buildup unable to be cleared by conventional means.