TITLE:
Endotracheal tube exchange and pneumothorax: A case report
AUTHORS:
Nissar Shaikh, Kasif Mahmood, Amr Aboul Wafa, Ousama Kokash
KEYWORDS:
AEC; Difficult Intubation; Pneumothorax; Thyroidectomy
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.2 No.2,
May
24,
2013
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.