DOI: https://doi.org/10.14710/jai.v0i0.85807

Role of Bronchoscopic Intervention as Management of Recurrent Airway Obstruction in Postpartum Patient with Preeclampsia: A Case Report

1Departemen Anestesiologi dan Terapi Intensif Universitas Indonesia, RSUPN dr. Cipto Mangunkusumo, Jl. Diponegoro No. 71, Kenari, Senen, Jakarta Pusat, Indonesia 10430. RSUPN dr. Cipto Mangunkusumo., Indonesia

2Departemen Anestesiologi dan Terapi Intensif Universitas Indonesia, RSUPN dr. Cipto Mangunkusumo., Jl. Diponegoro No. 71, Kenari, Senen, Jakarta Pusat, Indonesia 10430, Indonesia

Received: 19 Jun 2026; Revised: 18 Sep 2026; Accepted: 20 Oct 2026; Available online: 20 Oct 2026.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

Citation Format:
Cover Image
Abstract

Background Recurrent endotracheal tube obstruction caused by blood clots in postpartum respiratory failure patients is rarely discussed in obstetric critical care, despite its potential to induce sudden life-threatening hypoxemia and ventilatory failure. Risk factors include pulmonary capillary injury driven by sustained hypertension and endothelial dysfunction, alongside mucosal trauma from repeated endotracheal suctioning and underlying coagulation abnormalities. Early recognition and prompt bronchoscopic intervention are essential to improve outcomes.

Case We present a case of 42-year-old gravida 3 para 1 abortus 1(ectopic) woman with history of preeclampsia and gestational DM developed acute respiratory failure two hours after uncomplicated elective caesarean section. She was referred to our tertiary care ICU with severe hypoxemia, pulmonary edema and markedly elevated coagulation markers, consistent with severe ARDS and hypercoagulable state. During ICU treatment, she developed recurrent ETT obstruction by blood clots causing repeated desaturation episodes. Two emergency ETT exchanges were performed, the second following cardiorespiratory arrest requiring CPR. Given life-threatening conditions, urgent flexible bronchoscopic bronchial washing was performed bedside on day five. Bronchial washing achieved complete airway clearance with immediate improvement in oxygenation and ventilation. The patient was successfully extubated on day five and discharged in stable condition.

Discussion Identifying endotracheal tube obstruction by blood clots is inherently challenging, as its clinical presentation closely resembles bronchospasm, ventilator circuit failure, or acute deterioration of underlying pulmonary edema. Bedside flexible bronchoscopy confirmed the diagnosis through direct airway visualization and achieved definitive blood clots clearance. Early bronchoscopic intervention, when indicated, may prevent life-threatening hypoxemia and promote clinical improvement in patient.

Conclusion This case highlights the importances of early recognition and prompt bronchoscopic intervention in managing endotracheal tube obstruction by blood clots in postpartum preeclamptic patients with severe pulmonary complications, a rare but fatal in obstetric ICU patients.

 

Keywords: bronchoscopic; bronchial washing; postpartum respiratory failure; preeclampsia; recurrent blood clots.

Note: This article has supplementary file(s).

Fulltext View|Download |  Cover Letter
Cover Letter
Subject
Type Cover Letter
  Download (17KB)    Indexing metadata
 Copyright Transfer Agreement
Copyright Transfer Agreement
Subject
Type Copyright Transfer Agreement
  Download (772KB)    Indexing metadata
Email colleagues
Keywords: bronchoscopic; bronchial washing; postpartum respiratory failure; preeclampsia; recurrent blood clots

Article Metrics:

Article Info
Section: Case Reports
Language : EN
Most cited articles
Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida Patofisiologi Penyakit Jantung Koroner More cited articles
  1. Lapinsky SE. Acute respiratory failure in pregnancy. Obstet Med. 2015;8(3):126–32. doi: 10.1177/1753495X15589223
  2. Pollock W, Rose L, Dennis CL. Pregnant and postpartum admissions to the intensive care unit: A systematic review. Intensive Care Medicine. 2010;36(9):1465–74. doi: 10.1007/s00134-010-1951-0PubMedPMID:20631987
  3. Sundrani O, Raghuveer BT, Sahare KS, Shah PJ, Lalwani J. Interventions required and outcome in pregnancy induced hypertension patients in ICU: A observational study. Indian J Clin Anaesth. 2023;10(1):32–6. doi: 10.18231/j.ijca.2023.006
  4. Catanzarite V, Willms D, Wong D, Landers C, Cousins L, Schrimmer D. Acute respiratory distress syndrome in pregnancy and the puerperium: causes, courses, and outcomes. Obstet Gynecol. 2001;97(5 Pt 1):760–4. doi: 10.1016/s0029-7844(00)01231-x
  5. Naoum EE, Lindeman KS. Respiratory Disease. In: Wong CA, Kee WD, Tsen LC, Beilin Y, Mhyre JM, Bateman BT, et al., editors. Chestnut’s Obstetric Anesthesia. 7th ed. Philadelphia: Elsevier Inc; 2026.p. 1225
  6. Cunningham F G, Leveno K J, Bloom S L, Spong C Y, Dashe J S, Hoffman B L, et al., editors. Williams Obstetrics. 24th ed. New York: McGraw-Hill Education; 2014.p. 728–770
  7. Raia-Brajat T, Edebiri O, Ainle FN. Preeclampsia and venous thromboembolism: pathophysiology and potential therapy. Front Cardiovasc Med. 2022;9:856923. doi: 10.3389/fcvm.2022.856923
  8. Hasani KK, Ajeti N, Goswami N. Understanding preeclampsia: cardiovascular pathophysiology, histopathological insight and molecular biomarker. Med Sci. 2025;13(3):154. doi: 10.3390/medsci13030154
  9. Fanous J, Sakata KK. Diagnostic and Therapeutic Bronchoscopy in the Intensive Care Unit. In: Oropello JM, Pastores SM, Kvetan V, editors. Critical Care. 2nd ed. New York: Oxford University Press; 2025.p. 1353–62. doi: 10.1093/med/9780197628638.003.0117
  10. Zanev A. The role of bronchoscopy in intensive care medicine, case report. J IMAB. 2024;30(4):5834–7. doi: 10.5272/jimab.2024304.5834
  11. Kosinski S, Kluska M, Stachowicz J, Zietkiewicz M, Darocha T, Szlubowski A. Flexible bronchoscopy in mechanically ventilated critically ill patients: practical considerations and clinical applications-a narrative review. Anaesthesiol Intensive Ther. 2026;58:e49–58
  12. Tomimatsu T, Mimura K, Matsuzaki S, Endo M, Kumasawa K, Kimura Tadashi. Preeclampsia: maternal systemic vascular disorder caused by generalized endothelial dysfunction due to placental antiangiogenic factor. Int J Mol Sci. 2019;20(17):4246. doi: 10.3390/ijms20174246
  13. Narendra DK, Sharma M, Muigai D, Guntupalli KK. Acute respiratory distress syndrome in pregnancy. In: Pacheco LD, Phelan JP, Halscott TL, Moroz LA, Vaught AJ, Saad AF, et al., editors. Critical Care Obstetric. 7th ed. New Jersey: John Wiley & Son; 2024.p. 455–73
  14. Arney KL, Judson MA, Sahn SA. Airway obstruction arising from blood clot: three reports and review of the literature. Chest. 1999;115(1):293–300
  15. Karmy-Jones R, Cuschieri J, Vallieres E. Role of bronchoscopy in massive hemoptysis. Chest Surg Clin N Am. 2001;11:873–906
  16. Jolliet P, Chevrolet JC. Bronchoscopy in the intensive care unit. Intensive Care Med. 1992;18(3):160–9
  17. Sehgal IS, Dhooria S, Muthu V, Prasad KT, Agarwal R. Use of a Flexible Cryoprobe for Removal of Tracheobronchial Blood Clots. Respir Care. 2015;60(7):e128–31. doi: 10.4187/RESPCARE.03861
  18. Lloyd D, Carty A, Beavis S. Endobronchial streptokinase for airway thrombus: a case series. Crit Care. 2015;19(Suppl 1):291. doi: 10.1186/CC14291

Last update:

No citation recorded.

Last update: 2026-11-06 02:15:51

No citation recorded.