Case reports: Iatrogenic bronchial rupture following the use of endotracheal tube introducers

Şahin, Mehmet; Anglade, Daniel; Buchberger, Martine; Jankowski, A.; Albaladéjo, Pierre; Ferretti, G.

doi:10.1007/s12630-012-9763-z

Cited by 43 publications

(28 citation statements)

References 13 publications

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“…The tube is blindly inserted into the trachea or using the Seldinger technique using the tracheal click or distal holdup signs [12]. The endotracheal tube is, then, slided over the bougie, which is removed after accurate positioning of the tube [13].…”

Section: Discussionmentioning

confidence: 99%

Upper airway injury caused by gum elastic bougie

Özcan¹,

Balci²,

Aksoy³

et al. 2017

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes ABSTRACTIntroduction: Difficulties and complications associated with intubation are among the leading causes of surgery-related mortality in patients with obesity and obstructive sleep apnea. It is known that during perioperative intubations, the progression of the bougie may lead to serious injury and even rupturing in the trachea. Case Report: A 46-year-old ASA II patient was assessed preoperatively for uvuloplasty. His body mass index was 34.7. Preparation was completed for the difficult intubation. The patient could not directly intubated with laryngoscopy but was intubated with bougie in the second trial. After the surgery 200 mg bridion was administered and the patient was extubated. He was then followed-up in PACU. Due to the stridor, it was thought that there was edema in his upper airway. At 45 minutes of PACU follow-up, it was noticed that upper airway edema regressed but there was subcutaneous emphysema giving a sense of rattle during palpation in the periphery of the right eye. It spread rapidly over the face. Afterwards he was intubated again through video laryngoscopy due to the risk of upper airway obstruction. Fiber optic examination and thorax tomography revealed that the fistula line was on the left lateral wall following cricoid cartilage. Mucosal damage of the patient healed spontaneously and weaning was conducted three days later in the ICU. Conclusion: It was reported that tracheal injury and rupture occurs due to 'blind' advancement of the bougie during intubation. Due to the identification of subcutaneous emphysema at 45 minutes during follow-up, it was thought that the bougie caused injury in the patient. The close long-term postoperative follow-up is important in cases where difficult intubation is conducted with bougie and intubation is achieved through multiple trials.

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Section: Discussionmentioning

confidence: 99%

Upper airway injury caused by gum elastic bougie

Özcan¹,

Balci²,

Aksoy³

et al. 2017

IJCRI

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“…Airway injury by a bougie during difficult intubation can be prevented by avoiding the ‘hold up’ sign and should be retracted by a few centimetres before railroading the tracheal tube 4. The accidental advancement into smaller airway must be avoided by asking an assistant to hold it during the railroading 13.…”

Section: Discussionmentioning

confidence: 99%

“…Despite being a reliable aid to endotracheal intubation, tracheal introducers have been known to cause airway injuries such as pharyngeal perforation, mainstem bronchus bleeding, perforation of the tracheal mucosa and tracheal abrasion associated with haemopneumothorax 4. We present a case of bougie-associated bronchial injury followed by postoperative respiratory complications due to the formation of a nephropleural fistula after an uneventful percutaneous nephrolithotomy (PCNL) under general anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Bougie-associated bronchial injury complicated by a nephropleural fistula after percutaneous nephrolithotomy: a tale of two complications

Pande

Ramachandran

Rewari³

2018

BMJ Case Reports

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We present a case of bronchial injury following bougie-assisted endotracheal intubation in a patient with difficult airway scheduled to undergo right percutaneous nephrolithotomy under general anaesthesia. The patient developed pleuritic pain along with right pleural effusion on the third postoperative day which was diagnosed by the anaesthesiologist who was following up the patient for airway trauma-associated complications. However, the patient was diagnosed to have a nephropleural fistula, a rare complication of supracostal access to percutaneous nephrolithotomy, which was managed successfully.

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“…[2] However, the reports of airway trauma due to bougies, are limited to only a few case reports, and the incidence of bronchial injury even fewer. [34] Trauma was more often with single use bougies. [5] The coude tip of the bougie was designed to facilitate easy passage into the laryngeal inlet, and to prevent it from going too far down the airway, thereby reducing traumatic complications.…”

Section: Discussionmentioning

confidence: 99%