Intraoperative Tension Pneumothorax in a Patient With Remote Trauma and Previous Tracheostomy.

Ana Mavarez-Martinez,Gurneet Sandhu,Demicha Rankin,Suren Soghomonyan

doi:10.1177/2324709616636397

Abstract

Many trauma patients present with a combination of cranial and thoracic injury. Anesthesia for these patients carries the risk of intraoperative hemodynamic instability and respiratory complications during mechanical ventilation. Massive air leakage through a lacerated lung will result in inadequate ventilation and hypoxemia and, if left undiagnosed, may significantly compromise the hemodynamic function and create a life-threatening situation. Even though these complications are more characteristic for the early phase of trauma management, in some cases, such a scenario may develop even months after the initial trauma. We report a case of a 25-year-old patient with remote thoracic trauma, who developed an intraoperative tension pneumothorax and hemodynamic instability while undergoing an elective cranioplasty. The intraoperative patient assessment was made even more challenging by unexpected massive blood loss from the surgical site. Timely recognition and management of intraoperative pneumothorax along with adequate blood replacement stabilized the patient and helped avoid an unfavorable outcome. This case highlights the risks of intraoperative pneumothorax in trauma patients, which may develop even months after injury. A high index of suspicion and timely decompression can be life saving in this type of situation.

Highlights

Intraoperative tension pneumothorax is a dangerous complication of mechanical ventilation, which, if undiagnosed, is associated with a high mortality rate.[1]
Some of the trauma patients remain intubated for prolonged periods of time and may eventually need tracheostomy to facilitate their respiratory care.[4]
We present a patient with remote trauma and tracheal stenosis who developed tension pneumothorax during elective

Summary

Introduction

Intraoperative tension pneumothorax is a dangerous complication of mechanical ventilation, which, if undiagnosed, is associated with a high mortality rate.[1]. Some of the trauma patients remain intubated for prolonged periods of time and may eventually need tracheostomy to facilitate their respiratory care.[4] In some cases, the patients are discharged from the hospital with the tracheotomy tube in place, with an increased risk of late complications (tracheal stenosis, pneumonia, etc) requiring chronic treatment, including bronchoscopies, tracheal dilations, and other measures.[5]. Under such circumstances, application of positive pressure in a patient with a history of repetitive tracheobronchial manipulation poses a risk of tissue rupture and dissection along tissue planes. On postoperative day 4, the endotracheal tube was replaced with an XLT Shiley tracheostomy tube, and after 2 uneventful days, the patient was discharged to the chronic care facility

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Discussion

Conclusion