Korean J Anesthesiol.  2014 Nov;67(5):354-357. 10.4097/kjae.2014.67.5.354.

Management of traumatic pneumothorax with massive air leakage: role of a bronchial blocker: a case report

• Lee DK
• Lim SH
• Lim BG
• Kang SW
• Kim H

• KMID: 2039534
• DOI: http://doi.org/10.4097/kjae.2014.67.5.354

Abstract

Massive air leakage through a lacerated lung produces inadequate ventilation and hypoxemia. Tube exchange from a single to double lumen endotracheal tube (DLT), and lung separation to maintain oxygenation, are challenging for seriously injured patients. In this case report, we aim to describe how a bronchial blocker (BB) makes it easier to perform a lung separation in this situation; it also increases the overall safety of the procedure. A 35-year-old female (163 cm, 47 kg) suffered from blunt chest trauma due to a traffic accident; the accident caused right-sided lung laceration with massive air leakage. Paradoxically, positive ventilation worsened SaO2 and leakage increased through a chest tube. We introduced BB while the patient was still awake: Left-side one-lung ventilation (OLV) was established and anesthesia was induced. After PaO2 was maximized with OLV, we changed the endotracheal tube to DLT without a hypoxic event. By BB placement, we maintained PaO2 at a secure level, conducted mechanical ventilation and exchanged the tube without deterioration.

Keyword

Bronchial blocker; One-lung ventilation; Pneumothorax

MeSH Terms

Accidents, Traffic
Adult
Anesthesia
Anoxia
Chest Tubes
Female
Humans
Lacerations
Lung
One-Lung Ventilation
Oxygen
Pneumothorax*
Respiration, Artificial
Thorax
Ventilation
Oxygen