An ICU patient with acute stroke is undergoing airway suctioning. During the procedure, the patient suddenly develops expiratory wheeze and increased work of breathing. Which immediate complication is most likely?

1. A

   Pneumothorax

2. B

   Laryngospasm

3. C

   Atelectasis

4. D

   Bronchospasm and laryngospasm

Appeared in: NORCET 9 Mains - 2025

Explanation

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• The key symptom presented is a sudden expiratory wheeze, which is the hallmark sign of bronchospasm.
• Airway suctioning is a common trigger for bronchospasm due to mechanical irritation of the sensitive tracheobronchial mucosa.
• This irritation causes a reflex constriction of the smooth muscles in the bronchi, narrowing the airways and producing a wheezing sound on exhalation.
• While laryngospasm is also a potential complication from the same stimulus, bronchospasm directly explains the patient's primary symptom of expiratory wheezing.

Why Other Options Were Wrong

• Option A: Pneumothorax, or a collapsed lung, would present with absent or diminished breath sounds on the affected side, sudden sharp chest pain, and potentially hypotension, not expiratory wheezing.
• Option B: Isolated laryngospasm, a spasm of the vocal cords, causes upper airway obstruction. Its characteristic sign is inspiratory stridor (a high-pitched sound on inhalation), not expiratory wheeze.
• Option C: Atelectasis, the collapse of alveoli, leads to diminished breath sounds or fine crackles over the affected area and hypoxemia. It does not cause the active, high-pitched sound of wheezing.

Related Visual

• Visual 1: Diagram - An illustration comparing a normal airway, an airway in bronchospasm (narrowed bronchioles), and an airway in laryngospasm (closed vocal cords). This would help differentiate the anatomical locations of the complications.
• Visual 2: Flowchart - A decision-making flowchart for troubleshooting acute respiratory distress during suctioning, guiding the nurse based on whether they hear wheezing, stridor, or absent sounds.

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Complications of airway suctioning in acute care settings.
• Recognizing the signs of suctioning complications is a critical nursing skill. Misinterpreting expiratory wheeze as something other than bronchospasm could delay appropriate treatment (e.g., bronchodilators).
• The immediate nursing action for suspected bronchospasm is to stop suctioning, administer 100% oxygen, and notify the respiratory therapist and physician. The patient may require an inhaled bronchodilator.
• Patient Safety: Using the correct suctioning technique (pre-oxygenation, limiting pass duration to 10-15 seconds, using appropriate pressure) is paramount to preventing iatrogenic complications like bronchospasm, hypoxemia, and mucosal trauma.

How to Approach the Question

• First, identify the core components of the clinical scenario: a patient undergoing airway suctioning.
• Next, pinpoint the key clinical sign that develops: 'expiratory wheeze' and 'increased work of breathing'.
• Systematically evaluate each option, matching the pathophysiology to the key sign. Ask yourself, 'What sound does this complication produce?'
• Eliminate Pneumothorax because it causes absent breath sounds.
• Eliminate isolated Laryngospasm because it causes inspiratory stridor.
• Eliminate Atelectasis because it causes diminished sounds or crackles.

Concept Tested & Keywords

• Concept Tested: Complications of airway suctioning
• Stem keywords: airway suctioning, expiratory wheeze, increased work of breathing, immediate complication
• Lead-in keywords: most likely
• Clinical cues: ICU patient
• Clinical cues: acute stroke

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