# A Case of Mucus Plug Removal via Bronchoscopy Using a Larger-Sized Endotracheal Tube in a Child With Plastic Bronchitis

## TL;DR

A child with plastic bronchitis had mucus plugs successfully removed using a larger endotracheal tube during bronchoscopy, avoiding ECMO.

## Contribution

Demonstrates a novel bronchoscopy technique using a larger-sized endotracheal tube in pediatric plastic bronchitis.

## Key findings

- A larger cuffed endotracheal tube enabled successful mucus plug removal in a child with plastic bronchitis.
- The approach avoided the need for extracorporeal membrane oxygenation (ECMO) in a complex pediatric case.
- Flexible tube size selection based on patient condition is emphasized for effective bronchoscopic intervention.

## Abstract

Plastic bronchitis is a severe condition characterised by the formation of dendritic mucus plugs within the trachea and bronchi, leading to respiratory failure due to acute airway obstruction. Bronchoscopic mucus plug removal is considered effective; however, in paediatric patients, it is often difficult to perform due to limitations in tracheal tube size. We report a case of plastic bronchitis associated with influenza A infection during a relapse of nephrotic syndrome. Bronchoscopic mucus plug removal was performed using a cuffed endotracheal tube one size larger than standard, thereby avoiding the need for extracorporeal membrane oxygenation (ECMO). The use of modified cuffed tubes with minimal outer diameter differences highlights the importance of flexible size selection tailored to the patient's condition.