Tracheal stenosis can seriously affect respiratory function and cause respiratory distress. When the trachea is severely narrowed or even close to completely blocked, resulting in respiratory failure and extreme hypoxia, the patient may suffer life-threatening asphyxia and hypoxic cardiac arrest and die at any time, requiring emergency treatment. Whether the airway can be unblocked quickly and normal oxygenation can be restored in time to prevent asphyxia and hypoxic cardiac arrest is the key to the success or failure of resuscitation. Although surgical resection and airway reconstruction are clear treatment methods, surgical treatment is limited by the unknown etiology of tracheal stenosis and the critical condition of the patient, the anatomical limitation of the trachea (e.g., within 5 cm below the voice box) or metastatic tumor infiltration, and rapid tracheal intubation not only fails to save the patient’s life but sometimes poses a fatal risk, thus limiting its application to such patients. Therefore, for these patients, respiratory intervention becomes the only effective option. Most foreign countries choose to perform respiratory interventions by rigidoscopy to unblock the airway and save lives in a timely and effective manner. However, since rigid microscopy is not yet widely available in China and no imported jet ventilator is available in China, the search for effective respiratory intervention through bendable bronchoscopy has become inevitable. Respiratory failure due to tracheal stenosis is an extremely critical condition that can be caused by a variety of reasons, including malignant and benign lesions, with malignant lesions predominating. Among the 16 cases of respiratory failure due to tracheal stenosis, malignant tumors were found in 9 cases (56.3%), and locally invasive malignant tumors (especially postoperative recurrent invasive esophageal cancer) accounted for the majority of malignant lesions causing tracheal stenosis (77.8%). Among benign lesions leading to tracheal stenosis, invasive tracheal varices infection was the main etiology (71.4%). Among them, fungal infections due to radiotherapy and chemotherapy for malignancy are the main cause (80% of benign lesions). Tracheal stenosis can lead to respiratory failure. Since the obstruction is in the trachea, it first affects the ventilation function of the lungs, which later damages the clearance function of the trachea and leads to infection. In addition, the reduction or absence of ventilation leads to a decrease in the ventilation/blood flow ratio, which peaks when combined with pulmonary infections and atelectasis. This is more difficult to control in immunosuppressed patients. Tracheal stenosis is often not detected early. Because the airway is more stretchable and has a large reserve function, patients do not develop symptoms until the lesion has blocked or narrowed the airway to 1/2 to 1/3 of the normal lumen. Patients are generally asymptomatic when the tracheal internal diameter is narrowed to 10 mm, and often have dyspnea after activity when the diameter reaches 8 mm, but the arterial partial pressure of oxygen remains normal. When the diameter reaches 5 mm, the patient has dyspnea in a calm state with limited pseudo-cryptoacoustic sounds, inspiratory dyspnea and trismus. Severe dyspnea occurs only when the tumor occupies more than 2/3 to 3/4 of the tracheal inner diameter. Meanwhile, the early symptoms of tracheal stenosis are not obvious, lacking specific signs and symptoms, manifesting as irritating cough, coughing, wheezing, chest tightness after activity, shortness of breath, blood in sputum and other non-specific symptoms, which are often misdiagnosed as lung infection and bronchial asthma, with a misdiagnosis rate of 72%. For tracheal invasive aspergillosis, because the Aspergillus growth rate is very fast, often a few days can be completely blocked trachea, resulting in death by asphyxiation. Therefore, tracheal stenosis is often not timely and effective diagnosis. For the diagnosis of tracheal stenosis, chest CT is a reliable method to evaluate tracheal stenosis. In our data, tracheal stenosis was detected after chest CT in all 15 patients. In another case, recurrent polychondritis suggested the diagnosis of this disease after chest CT examination. Chest CT not only provides an accurate assessment of the length and degree of tracheal stenosis, which provides a basis for tailoring a suitable tracheal stent, but also evaluates the peri-tracheal abnormalities. Moreover, bronchoscopy provides further clarification of the diagnosis. In 16 patients, bronchoscopy was limited due to critical condition, but by performing ultra-fine bronchoscopy in 2 patients, it not only clarified the diagnosis but also compensated for the lack of chest CT examination (including 1 case of recurrent polychondritis). Laryngeal mask ventilation with general anesthesia has obvious advantages in respiratory interventions. Laryngeal mask is a new type of ventilation, which can guarantee the patient’s airway ventilation in general anesthesia. It can form a seal with the larynx after being placed in the pharynx, which allows the patient to breathe on his own and also to perform positive pressure ventilation, and is a ventilation tool between the tracheal tube and the mask. Compared with tracheal intubation, the laryngeal mask is easy to operate, easy to master, and does not require special instruments. The placement of laryngeal mask does not cause mechanical damage to the pharynx and trachea and has a slight effect on blood circulation. At the same time, the laryngeal mask is used to establish an artificial airway for general anesthesia without occupying the space in the patient’s airway, and even if there is an airway lesion, it will not cause significant obstruction, thus providing sufficient space for the operator to operate and ensuring the patient’s ventilation and oxygenation. In addition, the laryngeal mask is made according to the anatomical shape of the human body and does not enter the trachea, making it easier for the patient to tolerate and less foreign body sensation after surgery. The glands secrete less due to less stimulation. Also ciliary activity is not affected, reducing the chance of postoperative lung infection. The laryngeal mask can be inserted repeatedly for bronchoscopic treatment, effectively controlling breathing and improving hypoxia. And the time of treatment can be decided according to the degree and extent of stenosis, which can meet the demand of sufficient intervention time to achieve the best efficacy and improve the safety of microscopic treatment. If the laryngeal mask, bronchoscope and lump cannot be removed through the laparoscope, the laryngeal mask, bronchoscope and lump can be removed at the same time, which makes the intervention easy and safe. General anesthesia with laryngeal mask ventilation is currently the ideal anesthesia method for endotracheal interventions. For patients with tracheal stenosis, especially upper segment stenosis (within 5 cm below the voice box), general anesthesia with laryngeal mask ventilation is the only effective method to control the airway. Under general anesthesia with laryngeal mask ventilation, transbendable bronchoscopic interventions were performed in 16 patients with severe tracheal stenosis, whose treatments mainly included self-expanding metal stent placement, electrocautery, cryotherapy and balloon dilation, mostly in combination. For tracheal stenosis caused by malignant tumor, when respiratory failure occurs, timely and effective patency of trachea and improvement of hypoxia is the key. Therefore, it is important to remove the mass in the tracheal lumen promptly and rapidly. Among the rapid ablation techniques, mechanical resection, laser, electrocautery and other treatment methods are available. Most foreign countries use laser resection under a hard microscope, but with the development of respiratory interventional technology and in-depth research, electrocautery ablation can not only achieve the same therapeutic effect as laser treatment, but also be a safe and effective treatment method with low price. And with electrodes that can pass through the working orifice of both rigid and bendable bronchoscopes, the application of bendable bronchoscopes for electrocautery is more easily accepted in the background of less rigid techniques carried out in China. In nine cases of tracheal malignancy treatment, electrocautery was applied in eight of them for rapid ablation. In order to avoid bleeding that could lead to asphyxia, a mixed mode of coagulation and cutting was started and performed at the narrow end, and when the tracheal space was enlarged, it was switched to electrocautery or trap, while the oxygen supply concentration was kept below 40% when applying electrocautery treatment to prevent the high oxygen supply concentration from causing burning in the airway. To further maintain the patency of the trachea, we placed self-expanding metal stents in seven patients with malignant tracheal stenosis. The application of tracheal metal stents not only maintained the patency of the trachea, corrected hypoxia, maintained effective oxygenation and improved symptoms, but also prolonged patients’ lives, improved quality of life and significantly improved their lung function status. For severe tracheal stenosis caused by benign lesions, laryngeal mask ventilation under general anesthesia via bendable bronchoscopic intervention is equally safe and effective. After respiratory intervention, the degree of tracheal obstruction and shortness of breath index were significantly reduced. For tracheal stenosis caused by Aspergillus infection, freeze extraction + biopsy cleanup is mostly used with significant effect. Flushing with 2% voriconazole 100ml to 200ml is applied. For patients with recurrent polychondritis, temporary stenting is used to buy time for subsequent treatment. For multiple granulomatous proliferative lesions in the trachea, freeze-taking is mostly used as the main treatment. When the obstruction is severe, rapid ablation treatment by electrocautery ablation is applied first, followed by freeze-thaw and freeze-take with significant effect. Meanwhile, in benign stenosis, balloon dilatation under general anesthesia is performed in patients with severe tracheal stenosis caused by fungal necrotic material and granulation tissue, which can enlarge the stenosis and improve the ventilation function in a timely and effective manner, combined with other interventional treatment methods. Regardless of benign or malignant lesions, in cases of severe tracheal stenosis and respiratory failure, timely and effective airway patency and improvement of ventilation is the key. Therefore, respiratory intervention under general anesthesia with laryngeal mask ventilation via bendable bronchoscopy is effective. Through the interventional treatment of 16 patients with severe tracheal stenosis, the degree of tracheal obstruction and shortness of breath index scores were significantly reduced, and the hypoxic state was corrected in a timely and effective manner, which saved the patients’ lives. In the treatment of 16 patients with respiratory failure, no one death occurred, and no serious complications such as endotracheal burning and hemorrhage occurred, and the opportunity was gained for further related treatment and time was gained. In conclusion, respiratory intervention under general anesthesia with laryngeal mask ventilation via bendable bronchoscopy is safe, effective, and worthy of clinical application in the treatment of severe tracheal stenosis respiratory failure.