Bronchoscopic Cuff Tamponade for Post-Intubation Tracheal Bleeding.

Abstract

Introduction: Post-intubation tracheal bleeding is a rare but potentially life-threatening cause of haemoptysis, particularly in patients on antithrombotic therapy after transcatheter aortic valve implantation (TAVI). Early source identification and airway control are essential, with bronchoscopy central to diagnosis and management.

Case description: We report the case of a 66-year-old female who developed massive haemoptysis following TAVI and subsequent endotracheal intubation. Laboratory findings revealed a significant drop in haemoglobin, while imaging showed no evidence of parenchymal or vascular bleeding. Emergency bronchoscopy identified an active bleeding site on the posterior wall of the distal trachea. Under bronchoscopic guidance, the endotracheal tube cuff was repositioned and inflated to achieve direct tamponade. This intervention resulted in immediate and complete haemostasis. The cuff was maintained for 30 hours with close monitoring, and follow-up bronchoscopy confirmed cessation of bleeding and progressive mucosal healing. The patient was successfully extubated and discharged without recurrence.

Conclusion: Bronchoscopically guided endotracheal tube cuff tamponade is an effective, minimally invasive, and readily applicable technique for controlling localized tracheal bleeding.

Learning points: Tracheal bleeding after endotracheal intubation is a rare but potentially life-threatening cause of massive haemoptysis, particularly in patients receiving antithrombotic therapy after transcatheter aortic valve implantation.Early bronchoscopy is essential for accurate localization of the bleeding source and guidance of targeted, minimally invasive haemostatic interventions.Bronchoscopically guided endotracheal tube cuff tamponade is a simple, readily available, and effective bedside technique for controlling localized tracheal bleeding.