New mindful approach to procedure introduced at NUH to manage a potentially deadly condition impacting pregnant women | Latest news

• New mindfulness technique prevents sedation and improves patient experience
• Productivity in theatre triples and patients' time in hospital vastly reduced
• Mindful Endoscopy team at Queen’s Medical Centre (QMC) created after lockdown research
• Patients coming to QMC from 100 to 200 miles away.

A young woman who spent 14 months undiagnosed with a rare condition which left her “literally choking for days and almost dying”, has praised the work of Nottingham University Hospitals NHS Trust’s (NUH) for “saving my life”.

Daisy Betteridge was diagnosed with Laryngotracheal stenosis (LTS), a condition which narrows the upper airway, specifically the larynx (voicebox) and trachea (windpipe), causes difficulty breathing, coughing, and wheezing. It is often misdiagnosed as asthma for long periods.  There is a particular type of this condition that only affects women and often during the childbearing age.

NUH Consultant Ear Nose and Throat (ENT) Surgeon Professor Reza Nouraei has developed and been using mindfulness to make awake treatment of this condition less invasive. Which means faster recovery, less invasive approach. Fewer interventions for the patient, plus reduced time in hospital – improving flow and capacity

Professor Nouraei explained the condition can lead to severe consequences: “During labour, the medical team could end up needing to put a tube down as a life saving measure if they think the patient is having an “asthma attack” but couldn’t, because of the narrowing of windpipe due to the condition masquerading as asthma. This could end in tragedy.”

The  NUH research aimed to see if mindfulness could enable awake endoscopies to be routinely carried out in as many as 20 patients a day. Professor Nouraei explained: “Under lockdown in Covid, one of the things for stress was the Headspace app which was given to all NHS staff, and it helped me learn techniques that could help with breathing. Letting the breath out longer brings the heartrate down which gives the body a signal that all is good.

“Coming back out of lockdown I brought some of those breathing techniques to help stopping coughing and holistic support for the patient and made it into a process that allowed patients to have the stress deescalated. That prevents having to sedate patients.”

As a result, they created a Mindful Endoscopy team at Queen’s Medical Centre (QMC) in Nottingham to guide patients through the procedure using a range of mindfulness practices.

Professor Nouraei explained: “For the past 18 months in Nottingham, we have been using perioperative mindfulness to offer interventions to up to 22 patients with airway and voice problems in a single operating list. Before, when the same procedures used to need general anaesthesia, we could only operate on six to seven patients per day.”

The professor explained what these relatively quick steroid injections into the airway and vocal chords means for pregnant women with this rare variant. He said: “So far, five ladies, through this new procedure, have been able to give birth in their chosen hospital with no over medicalisation as a result of this long-term condition which needs minor interventions through their life.”

One of those ladies was Daisy from Nuneaton. It took 14 months for Daisy to be diagnosed. After getting Covid in 2020 she was told it was probably long covid.  

Daisy remembered: “Even a three-minute walk with my son to drop him off at nursery would leave me gasping for breath.”

When Daisy was referred to QMC she presented with an 80-90% blocked airway and was very breathless and nine weeks pregnant. She was taken in for an emergency endoscopic laryngotracheoplasty—a minimally-invasive procedure—which immediately restored Daisy’s ability to breathe normally. With steroid injections before going into labour, to make sure the airway stayed open, she was able to go into her local hospital to give birth naturally without any over-medicalisation.

Professor Reza Nouraei said: “Injecting steroids into the airway and into the vocal chords is not a new technique but to be able to do this procedure on an awake patient using mindfulness is.

“We believe this frees up operating theatres and reduces waiting lists for many other procedures. We hope that this approach could be applied in different clinical settings, and across different procedures.”

Daisy said: “I think I would have died. There were a few times where I got mucus stuck and it was really scary.I honestly think I would have died had I not had the op.

“I was literally choking over days. The prof saved my life. I can’t thank him enough. Being pregnant your body is under enough pressure so to then have this condition it can be really, really dangerous. I will always thank my lucky stars for Prof!”

Professor Nouraei added: “We’ve had cases in the past with ladies having a tracheostomy (a tube in the neck) for 10 years after pregnancy. But thanks to this new procedure, we have not had any cases  like that in the past 3 years.

“People are coming to QMC from 100 to 200 miles away. It is better for the patients, and it literally triples our productivity in theatre.”

 Daisy explained: “If I didn’t have the injections, I would need operations more regularly but I would be symptomatic more regularly which is a place I do not want to go back to.”