Unexpected Tension Pneumothorax after Double-Lumen Endotracheal Intubation in Patients with Pulmonary Edema: A Case Report

Baek, Jongyoon; Park, Soo‐Jin; Seo, Myungjin; Choi, Eun Kyung

doi:10.3390/medicina59030460

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…In this case, surgical manipulation likely caused the DLT to shift, resulting in malpositioning and subsequent barotrauma, where the entire tidal volume was delivered preferentially to the left lower lobe. This scenario aligns with previous reports highlighting the risk of barotrauma from DLT malpositioning during thoracic surgery [11][12][13].…”

Section: Discussionsupporting

confidence: 92%

Management of Bilateral Tension Pneumothorax with Extensive Subcutaneous Emphysema during One-Lung Ventilation

Baadi,

Kachani,

Jeddab

et al. 2024

J. Adv. Med. Med. Res.

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Introduction: Intraoperative complications during thoracic procedures requiring one-lung ventilation (OLV) are rare but life-threatening. Double-lumen endotracheal tubes (DLTs) are commonly used but can lead to complications such as bilateral tension pneumothorax, posing significant challenges for anesthesiologists and thoracic surgeons. This case report highlights a critical incident during a mediastinoscopy under general anesthesia with OLV. Case Presentation: A 43-year-old male with a history of Hodgkin’s lymphoma underwent a mediastinoscopy. Anesthesia induction and intubation with a 37 French Carlen DLT were performed. Shortly after initiating OLV, the patient experienced sudden hypoxemia (SpO2 65%), increased peak airway pressures, bradycardia, and hypotension. Bilateral tension pneumothorax with subcutaneous emphysema was diagnosed, and emergency bilateral chest drain insertion stabilized the patient. Discussion: This case illustrates the severity of DLT-associated complications, particularly tension pneumothorax caused by tube malpositioning and barotrauma. Diagnosing tension pneumothorax is challenging due to similar symptoms with other intraoperative issues. Clinical signs include severe hypoxemia, hypercarbia, hypotension, and increased airway pressures. Rapid diagnosis through chest X-rays and ultrasonography, along with immediate management, such as chest drain insertion, is crucial. Conclusion: The case emphasizes the importance of vigilance and preparedness to manage anesthetic complications during thoracic procedures. Rigorous verification of DLT positioning, continuous monitoring, and prompt interventions are essential to prevent catastrophic events.

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Section: Discussionsupporting

confidence: 92%

Management of Bilateral Tension Pneumothorax with Extensive Subcutaneous Emphysema during One-Lung Ventilation

Baadi,

Kachani,

Jeddab

et al. 2024

J. Adv. Med. Med. Res.

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“…Rather rare the reason for conversion was the post-inverted damage of the two-way tube of the membrane bifurcation of the trachea (n = 2, 9.1%), which coincides with the data of other researchers (Baek et al , 2023). In any case, the emphysema of the posterior mediastinum was observed at VATS.…”

Section: Discussionsupporting

confidence: 91%

Modifications to the video-assisted thoracoscopic surgery technique reduce 1-year mortality and postoperative complications in intrathoracic tumors

Makarov

Yessentayeva

Kadyrbayeva

et al. 2023

European Journal of Cancer Prevention

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Objective The purpose of the study is to analyze the immediate outcomes and results of video-assisted thoracoscopic lobectomy and lung resection performed in the surgical department of the AOC between 2014 and 2018. Methods For the period from 2014 to 2018, 118 patients with peripheral lung cancer were operated on in the surgical department of the AOC. The following operations were performed: lobectomy in 92 cases (78%), of which: upper lobectomy, 44 (47.8%); average lobectomy, 13 (14.1%); lower lobectomy, 32 (35%); bilobectomy, 3 (3.3%). All patients underwent extensive lymphadenectomy on the side of the operation. In 22 patients, for various reasons, preservation of thoracotomy was performed. Results The absence of N0 lymph node damage was observed in 82 patients (70%), the first-order lymph node damage N1 in 13 (11%), N2 in 13 (11%), N3 in 5 (4%), and NX in 5 (4%). Histological examination revealed: squamous cell carcinoma − 35.1%, adenocarcinoma − 28.5%, undifferentiated carcinoma − 8.3%, NSCLC − 5.6%, NEO − 4.6%, sarcoma − 1.8%. At the same time, in 12.7% of patients, mts was detected − lung damage, and in 3.4%, malignant cells were not detected. Most patients were activated on the first day after surgery. Conclusion An analysis of the direct results of the study allows us to conclude that video-assisted thoracoscopic surgery is a highly effective, minimally invasive, safe method for treating peripheral lung cancer, which allows us to recommend it for wider use in oncological practice.

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“…Thoracoscopic technology under nonintubated local anaesthesia and sedation has been gradually applied in the clinic to avoid complications related to tracheal intubation and mechanical ventilation and reduce the hospitalisation cost of patients. Thoracoscopic surgery under spontaneous respiration requires anaesthesiologists to retain the patients' spontaneous respiration under general anaesthesia and no longer uses traditional single-lumen tracheal intubation and ventilator-assisted respiration to avoid the injuries of the trachea and glottis and the barotrauma inflicted by the ventilator on pulmonary alveoli as well as reduce a series of postoperative complications caused by tracheal intubation and ventilator-assisted ventilation [8,9]. Thoracoscopic surgery under spontaneous respiration mainly adopts laryngeal mask ventilation, which could not stimulate the glottis during anaesthesia, by utilising open pneumothorax formed after thoracotomy, showing simple placement, low stimulation to patients' respiratory tracts and good tolerance [10,11].…”

Section: Discussionmentioning

confidence: 99%

Effect of Thoracoscopic Surgery under Spontaneous Respiration on Inflammatory Indicators and Postoperative Complications in Elderly Patients with Primary Spontaneous Pneumothorax

Xiao,

Xia

2024

HSF

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Background: In thoracoscopic surgery under spontaneous respiration, patients could breathe spontaneously during surgery without the need for mechanical ventilation via tracheal intubation. This technique can effectively avoid the injuries caused by tracheal intubation and mechanical ventilation and the side effects of muscle relaxants, thus reducing postoperative complications and benefitting patients. This study aims to explore the application of thoracoscopic surgery under spontaneous respiration in the elderly with primary spontaneous pneumothorax (PSP) and its effect on inflammatory indices and postoperative complications. Methods: The medical records of 181 elderly patients with PSP who underwent thoracoscopic surgery in our hospital from June 2021 to June 2022 were chosen for retrospective analysis. After excluding 15 patients who did not meet inclusion criteria, 80 patients receiving spontaneous respiration via laryngeal mask ventilation were included in the study group and 86 patients undergoing pulmonary ventilation via single-lumen tracheal intubation were included in the control group in accordance with the different schemes used in the surgery. Preoperative anaesthesia induction, surgical and hospitalisation times were compared, and the haemodynamics and inflammatory indices and complication incidences of the two groups were analysed. Results: Recovery time and hospitalisation time significantly differed between the two groups (p < 0.001). Compared with the control group, the study group had significantly lower mean arterial pressure at T2 and faster heart rates at T2 and T3 (p < 0.001). At T5, T6 and T7, the levels of interleukin-6, interleukin-8 and C-reactive protein in the study group were significantly lower than those in the control group (p < 0.05). The incidence of intraoperative and postoperative complications did not significantly differ between the two groups (p > 0.05). Conclusion: Thoracoscopic surgery under spontaneous respiration is safe and effective in the treatment of elderly patients with PSP. It reduces the levels of inflammatory factors and accelerates postoperative rehabilitation, showing certain value for clinical promotion.

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Unexpected Tension Pneumothorax after Double-Lumen Endotracheal Intubation in Patients with Pulmonary Edema: A Case Report

Cited by 4 publications

References 18 publications

Management of Bilateral Tension Pneumothorax with Extensive Subcutaneous Emphysema during One-Lung Ventilation

Management of Bilateral Tension Pneumothorax with Extensive Subcutaneous Emphysema during One-Lung Ventilation

Modifications to the video-assisted thoracoscopic surgery technique reduce 1-year mortality and postoperative complications in intrathoracic tumors

Effect of Thoracoscopic Surgery under Spontaneous Respiration on Inflammatory Indicators and Postoperative Complications in Elderly Patients with Primary Spontaneous Pneumothorax

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