Don't Be an Obstructionist

A 47 year-old male with a mature tracheostomy presented for spot grafting of multiple sites following excision and grafting for thirty-six percent total body surface area thermal burns. Despite previous stability on room air, the patient became hypoxic and difficult to ventilate following a combined inhalational and intravenous induction. Broncoscopy revealed a previously unrecognized, fixed obstructive mass immediately distal to the tracheostomy tube, which was later determined to be granulation tissue. The patient was woken up, placed in an upright position, and resumption of spontaneous ventilation was achieved with improvement of both oxygenation and ventilation.