title: The diagnostic challenge of a tracheal tear with a double-lumen endobronchial tube: massive air leak developing from the mouth during mechanical ventilation.
abstract: The case of a 78 year-old woman who underwent a right lower lobectomy using a 35-French, left-sided, double-lumen endobronchial tube (DLET) is presented. Multiple adjustments were needed for the DLET's proper placement. At the end of surgery, sudden loss of tidal volume with a large air leak from the patient's mouth was noted. Fiberoptic bronchoscopic examination through the DLET was negative. Rupture of the tracheal cuff was suspected, and the DLET was replaced with a single-lumen tube. In the intensive care unit, the massive air leak from the mouth recurred during mechanical ventilation. Nasal fiberoptic bronchoscopic examination showed a longitudinal laceration of the membranous portion of the trachea extending from the subglottic area to the orifice of the right bronchus. Surgical repair of the tear was performed.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, UPMC Montefiore, Pittsburgh, PA 15213, USA.
authors.forename: Vani
authors.initials: V
authors.lastname: Venkataramanappa
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Boujoukos
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sakai
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D001980:Bronchi / Q000502:physiology; D001999:Bronchoscopy; D003422:Critical Care; D017809:Fatal Outcome; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000628:therapy; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008168:Lung / Q000601:surgery; D016343:Monitoring, Intraoperative; D009055:Mouth; D009102:Multiple Organ Failure / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology / Q000382:microbiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012121:Respiration, Artificial; D012421:Rupture / Q000209:etiology / Q000473:pathology; D014132:Trachea / Q000293:injuries*; D015919:Ventilators, Negative-Pressure