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Background: The Cook® Airway Exchange Catheter (Cook® AEC, Cook Group Incorporated, Bloomington, Indiana, USA) is an 83-cm-long graduated hollow tube with an external diameter of 11, 14, or 19 French, commonly used for tracheal tube replacement. Although this application is reliable in the exchange of single-lumen tubes, the failure rate markedly rises during the exchange from a single-lumen to a double-lumen endotracheal tube. It is also often used as a bridge to extubation in patients with difficult airways and for oxygenation support applications. Case Report: We describe the case of a 58-year-old patient with unexpected difficult airway management. He was scheduled to undergo a minimally invasive hybrid esophagectomy (laparoscopic abdominal stage followed by an open right thoracotomy, requiring one-lung ventilation with a double-lumen tube). After the laparoscopic abdominal stage, performed with a single-lumen endotracheal tube, we exchanged it for a double-lumen endotracheal tube. After several unsuccessful exchanges with a Cook® Airway Exchange Catheter due to the flexibility of the exchange catheter, we decided to use the exchange catheter as a method to maintain adequate ventilation while using it as a target to facilitate tracheal intubation alongside it, using a videolaryngoscope. Conclusions: This case report discusses an unusual use of the Cook® Airway Exchange Catheter during videolaryngoscopic double-lumen endotracheal tube (DLT) intubation. It reviews previously documented uses in the literature, while highlighting the possibility of failure during tube exchange. It also highlights its value as a support for oxygenation and ventilation during difficult intubation attempts. [ABSTRACT FROM AUTHOR]

The indications for rigid bronchoscopy for interventional pulmonology have increased and include stent placements and transbronchial cryobiopsy procedures. The shared airway between anesthesiologist and pulmonologist and the open airway system, requiring specific ventilation techniques such as jet ventilation, need a good understanding of the procedure to reduce potentially harmful complications. Appropriate adjustment of the ventilator settings including pause pressure and peak inspiratory pressure reduces the risk of barotrauma. High frequency jet ventilation allows adequate oxygenation and carbon dioxide removal even in cases of tracheal stenosis up to frequencies of around 150 min−1; however, in an in vivo animal model, high frequency jet ventilation along with normal frequency jet ventilation (superimposed high frequency jet ventilation) has been shown to improve oxygenation by increasing lung volume and carbon dioxide removal by increasing tidal volume across a large spectrum of frequencies without increasing barotrauma. General anesthesia with a continuous, intravenous, short-acting agent is safe and effective during rigid bronchoscopy procedures. [ABSTRACT FROM AUTHOR]