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KMID : 0356920140670050354
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Korean Journal of Anesthesiology
2014 Volume.67 No. 5 p.354 ~ p.357
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Management of traumatic pneumothorax with massive air leakage: role of a bronchial blocker: a case report
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Lee Dong-Kyu
Lim Sang-Ho
Lim Byung-Gun
Kang Sung-Wook
Kim Hee-Zoo
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Abstract
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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.
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KEYWORD
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Bronchial blocker, One-lung ventilation, Pneumothorax
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