title: Management of traumatic pneumothorax with massive air leakage: role of a bronchial blocker: a case report.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea.
authors.forename: Dong Kyu
authors.initials: DK
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea.
authors.forename: Sang Ho
authors.initials: SH
authors.lastname: Lim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea.
authors.forename: Byung Gun
authors.initials: BG
authors.lastname: Lim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea.
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Kang
authors.affiliation: Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea.
authors.forename: Heezoo
authors.initials: H
authors.lastname: Kim
keywords: Bronchial blocker; One-lung ventilation; Pneumothorax