Endotracheal tube exchange and pneumothorax: A case report

Nissar Shaikh, Kasif Mahmood, Amr Aboul Wafa, Ousama Kokash

Department of Anesthesia/ICU, Hamad Medical Corporation, Doha, Qatar.
Department of Anesthesia/ICU, Weill Cornell Medical College in Qatar, Doha, Qatar;.
Department of Surgery, Hamad Medical Corporation, Doha, Qatar.

DOI: 10.4236/crcm.2013.22050                

Abstract

Endotracheal intubation and extubation in intensive care unit (ICU) patients are difficult. Extubation will be more worrisome if patient has difficult intubation, sleep apnea, surgical procedure involving airway or surrounding structures. In such extubation airway exchange catheters (AEC) are used, as they are simple to use and able to provide oxygen to the patient. Rarely AEC use can cause potential life threatening complications. We report a case of pneumothorax following use of AEC in post-thyroidectomy patient. Case: A 32 years old male patient was admitted to our ICU, with difficult intubation after thyroidectomy. He was a known case of obtructive sleep apnea, hypertension and large goiter. In ICU for proper visualization of vocal cords and resecuring the airway, AEC was used, but patient had hypoxia with bradycardia. He was recovered with Ambu bag ventilation and required brief cardiopulmonary resuscitation. Post resuscitation he had left impending tension pneumothorax and lung laceration requiring chest drain, which was removed after tracheostomy and weaned from the ventilator. After 9 days supra glottic edema subsided and vocal cords were moving; His trachea was decanulated and he was discharged home. Conclusion: Rarely AEC use can cause life threatening injuries. Pneumothorax following the use of AEC is not always due to tracheobronchial injury; it can also occur as a result of alveolar injury.

Keywords

AEC; Difficult Intubation; Pneumothorax; Thyroidectomy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Mort, T.C., Meistering, E.M. and Waberski, W.M. (1997) Exchanging a tracheal tube in ICU patients; a comparison of two exchangers with direct laryngoscopy. Anesthesiology, 87, 2402.
[2]	Benumof, J.L. (1999) Airway exchange catheters simple concept, potentially great danger. Anesthesiology, 91, 342-344. doi:10.1097/00000542-199908000-00005
[3]	Liudermilk, E.P., Hartmannsgruber, M., Stoltzfus, D.P. and Langevin, P.B. (1997) A prospective study of safety of tracheal extubation using a pediatric airway exchange catheter for patients with known difficult airway. Chest, 111, 1660-1665. doi:10.1378/chest.111.6.1660
[4]	Harris, K., Chalhoub, M., Maroun, R. and Elsayegh, D. (2012). Endotracheal tube exchangers: Should we look for safer alternatives? Heart Lung, 41, 67-69. doi:10.1016/j.hrtlng.2011.06.005
[5]	Nates, J.L. and Berner, D.K. (2001) Mishaps with ETT exchangers in ICU. Two case reports and review of literature. The Internet Journal of Anesthesiology, 5, 1.
[6]	Thoongsuwan, N., Kanne, J.P. and Stem, E.J. (2005) Spectrum of blunt chest injuries. Journal of Thoracic Imaging, 20, 89-97. doi:10.1097/01.rti.0000148210.89718.f5
[7]	Peral, D., Porcar, E., Bellver, J., Higueras, J., Onrubia, X. and Barbara, M. (2006) Glide scope video-laryngoscopy is useful in exchanging endotracheal tubes. Anesth Analog, 103, 1043-1044. doi:10.1213/01.ane.0000239066.91950.6a
[8]	Baraka, A.S. (1999) Tension pneumothorax complicating jet ventilation via a Cook airway exchange catheter. Anesthesiology, 91, 557-558. doi:10.1097/00000542-199908000-00031
[9]	Chin, J.H., Lee, E.H., Choi, D.K. and Choi, I.C. (2010) High frequency jet ventilation of one lung using a bronchial blocker of univent during carinal resection. Journal of Korean Medical Science, 25, 1083-1085. doi:10.3346/jkms.2010.25.7.1083