title: Transbronchoscopic oxygen insufflation-induced barotrauma during endobronchial silicon spigot removal.
abstract: While transbronchoscopic air insufflation has been described in refractory atelectasis as a therapy without any serious complications, 3 cases of gastric rupture during the same procedure have been reported when it was used to support tracheal intubation by employing the jet of oxygen from the wall pipeline. Here, we report a 66-year-old woman who underwent transbronchoscopic oxygen insufflation using a flexible fiberscope to clear away secretions during an endobronchial silicon spigot removal procedure. She suffered a sudden drop of blood pressure with pneumomediastinum, subpleural and subcutaneous emphysema, and bilateral pneumothorax. Blood pressure recovered rapidly when we stopped the insufflation. Tube thoracostomy was initiated, and she recovered well without systemic air embolism. We conclude that transbronchoscopic oxygen insufflation using the wall pipeline does carry a potential risk of serious barotrauma, and is not to be recommended except with the use of a pressure monitor or pop-off valve.
authors.affiliation: Department of Chest Surgery, Toho University Omori Medical Center, Tokyo, Japan. yoshinobuhata@hotmail.com
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Hata
authors.forename: Fumitomo
authors.initials: F
authors.lastname: Sato
authors.forename: Keigo
authors.initials: K
authors.lastname: Takagi
authors.forename: Hidenori
authors.initials: H
authors.lastname: Goto
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tamaki
authors.forename: Hajime
authors.initials: H
authors.lastname: Otsuka
mesh_terms: D000368:Aged; D001469:Barotrauma / Q000209:etiology*; D001980:Bronchi; D001999:Bronchoscopy; D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D007327:Insufflation / Q000009:adverse effects* / Q000379:methods*; D010100:Oxygen / Q000008:administration & dosage; D012825:Silicon
chemical_list: D010100:Oxygen; D012825:Silicon