Although type 2 respiratory failure is a plausible late presentation for laryngeal tumours, very little published literature is available to support this theory.

This paper describes the unusual presentation of a subglottic tumour with uncompensated type 2 respiratory failure.

The patient was initially managed with biphasic positive airway pressure as a bridging measure while awaiting intensive care treatment and to provide sufficient time to arrange a surgical tracheostomy.

This case highlights the importance of clinical suspicion towards subglottic tumours in patients presenting with type 2 respiratory failure. The positive outcome indicates that biphasic positive airway pressure is a potential bridging therapy for upper airway obstruction and a safe and stable treatment option for patients in respiratory distress.