Maintaining oxygenation with high-flow nasal cannula during emergent awake surgical tracheostomy

Editor—Patients presenting with acute upper airway obstruction are at significant risk of morbidity and continue to be managed poorly.¹ Although several approaches can be taken, surgical tracheostomy placement under local anaesthesia is recommended because it ensures patients are kept awake, maintaining airway patency.² This poses several challenges for the anaesthetist, including limited access to the surgical field and risk of complete airway obstruction in a patient with potentially limited reserve.

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