Barotrauma following liquid nitrogen spray cryotherapy for airway recanalization

Abstract

Spray cryotherapy (SCT) using the truFreeze® system (Steris, Mentor, Ohio, USA) is a minimally invasive technique that is becoming increasingly common for airway stenosis management. Although generally considered safe, rare but serious, high-morbidity complications such as barotrauma can occur. We report the case of a 49-year-old female with a history of tracheal and subglottic stenosis who developed a pneumothorax during airway recanalization with truFreeze® cryotherapy. This complication occurred despite the use of standard safety protocols and safeguards, including passive venting. Shortly after the initiation of the cryotherapy, significant abdominal distention was detected, prompting immediate cessation of the procedure. Subsequently, the patient developed transient hypoxemia, and imaging confirmed a left-sided pneumothorax with mediastinal shift. A chest tube was inserted with near-complete resolution of the pneumothorax and associated symptoms. The patient was then discharged in stable condition. This case demonstrates the necessity of intraoperative vigilance and preparation for high-risk complications when using the truFreeze® system. As its usage becomes more widespread, clinicians must have preplanned interventions for barotrauma in order to increase early recognition, timely management, and improved patient outcomes.

Abbreviations: ED: Emergency department, LMA: laryngeal mask airway, PSI: pounds per square inch, SCT: Spray cryotherapy

Keywords: Spray Cryotherapy, Airway Stenosis, Barotrauma, Pneumothorax, Tracheal Recanalization

Citation: Martin-Orr N, Choy J, Rajan G. Barotrauma following liquid nitrogen spray cryotherapy for airway recanalization. Anaesth. pain intensive care 2025;29(8):1044-1046. DOI: 10.35975/apic.v29i8.3033

Received: June 20, 2025; Revised: August 03, 2025; Accepted: August 28, 2025