Oxygenation Through the Working Channel of Fiberscope During Awake Tracheal Intubation in Severe Glottic Edema Following Caustic Agents Injury.

BACKGROUND

Airway management in the context of caustic ingestion and subsequent laryngeal edema is fraught with complexity and urgency. Awake tracheal intubation (ATI), particularly with continuous oxygen insufflation via the fiberscope's working channel, represents a refined approach that preserves oxygenation and enhances procedural success in anticipated difficult airways.

CASE REPORT: We present the case of a 48-year-old male presenting with acute respiratory distress following accidental caustic ingestion. Despite initial stabilization, progressive desaturation and imaging-confirmed laryngeal edema necessitated urgent airway control. ATI was performed using combined video laryngoscopy and flexible bronchoscopy, with continuous oxygen delivered through the fiberscope. This maintained optimal oxygenation, improved visualization, and facilitated successful intubation after downsizing the endotracheal tube due to severe glottic narrowing. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case underscores the critical value of continuous oxygen insufflation during ATI in edematous airway emergencies. By prolonging safe oxygenation time and improving visual clarity, this technique emerges as a compelling adjunct in securing compromised airways, particularly when anatomical distortion precludes conventional intubation.