Critical airway obstruction associated with extensive subglottic inflammatory slough and oedema following severe acute respiratory syndrome SARS-CoV-2 infection in a child.

SARS-CoV-2 infection in children is typically mild, although COVID-19-associated croup can be severe. We report a patient in middle childhood with impending critical airway obstruction due to severe subglottic oedema and extensive inflammatory slough/crusting following SARS-CoV-2 infection. Subsequent airway assessment in the operating theatre revealed critical subglottic narrowing. During transport, nebulised epinephrine was initiated; however, the patient developed hypoxaemia (SpO2 80%) with loss of consciousness. On arrival, video-laryngoscopic removal of obstructive slough using Magill forceps and Yankauer suction restored spontaneous ventilation with forceful expectoration of residual debris. Because of persistent severe oedema, endotracheal intubation required a markedly undersized tube for the patient's predicted size (internal diameter 4.5 mm). Following unplanned self-extubation on day 1, residual subglottic oedema and slough were managed with nebulised epinephrine and dexamethasone without re-intubation. The patient was discharged on day 10 without complications. This case highlights the importance of definitive airway management in a controlled setting.