Emergency management of patients with tracheal collapse

Introduction

Tracheal collapse occurs frequently in small breeds. Both the intrathoracic and extrathoracic portions may be affected, also extending into the main bronchus.

Its aetiology lies in a deficiency in the cartilage matrix, which results in a collapse of the tracheal lumen.

 

Diagnosis

I) Clinical signs: cough, severe cough after exercise-excitation, syncope after coughing episode, hyperthermia, moderate to severe respiratory distress.

II) Cervical – thoracic, lateral and dorsoventral radiographs: – Inspiration: a narrowing of the extrathoracic tracheal portion and a widening of the intrathoracic portion can be seen on the lateral radiograph. – Exhalation: the lateral X-ray shows a dilatation of the cervical-extrathoracic portion and a narrowing of the intrathoracic portion.

III) Fluoroscopy

IV) Bronchoscopy

 

Emergency management and treatment

I) Oxygen therapy and sedation (butorphanol and/or acepromazine).

II) Anti-inflammatory doses of corticosteroids: 0.5 mg/kg IV methylprednisone.

III) Terbutaline 0.01 mg/kg IV, SC

IV) Active cooling of the patient if temperature > 39.5ºC.

V) Patients who must be intubated and cannot be extubated due to further collapse each time it is attempted are candidates for emergency surgery or tracheal stenting.

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