“Life-threatening” Hypoxemia in One-lung Ventilation

Tracheobronchial injuries are rare but life threatening sequel of blunt chest trauma. Due to the difficult nature of these injuries and the demanding attributes of the involved surgery, the anesthesiologist faces tough challenges while securing the airway, controlling oxygenation, undertaking one-lung ventilation, maintaining anesthesia during tracheal reconstruction, and gaining adequate postoperative pain control. Amongst the few techniques that can be used with tracheobronchial injuries, cross field ventilation is a remotely described and rarely used technique, especially in injuries around the carina. We effectively applied cross field ventilation in both our cases and the outcome was excellent.

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Thoracics

Emergencies in Anaesthesia ◽

10.1093/med/9780198758143.003.0008 ◽

2020 ◽

pp. 215-246

Author(s):

James Bennett ◽

Gerard Gould

Keyword(s):

Best Practice ◽

Bronchopleural Fistula ◽

Management Strategies ◽

Lung Ventilation ◽

Bronchial Obstruction ◽

Dynamic Hyperinflation ◽

One Lung Ventilation ◽

Cardiac Herniation ◽

Life Threatening ◽

Practice Methods

In this chapter on life-threatening thoracic problems in anaesthesia, the authors offer their guidance and expertise on the best-practice methods of dealing with each of these. These problems include tracheal/bronchial obstruction, inhaled foreign body, tracheal injury or laceration, bronchopleural fistula, hypoxia/pneumothorax/high airway pressure during one-lung ventilation, dynamic hyperinflation, cardiac herniation postpneumonectomy, major airway bleeding, and bleeding during mediastinoscopy. In addition, the definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations for each potential thoracically related situation are given and elaborated upon. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.

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Contralateral tension pneumothorax during video-assisted thoracic surgery for lung cancer in a patient with obesity and rib fractures: a case report and review of the literature

Journal of Medical Case Reports ◽

10.1186/s13256-020-02556-w ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Sakiko Kumata ◽

Katsunari Matsuoka ◽

Shinjiro Nagai ◽

Mitsuhiro Ueda ◽

Yoshinori Okada ◽

...

Keyword(s):

Lung Cancer ◽

Past History ◽

Tension Pneumothorax ◽

Lung Ventilation ◽

Rib Fractures ◽

Review Of The Literature ◽

One Lung Ventilation ◽

Life Threatening ◽

History Of ◽

Life Threatening Complication

Abstract Background Intraoperative contralateral pneumothorax during one-lung ventilation is a rare but life-threatening complication. Although the exact incidence is unknown, only 14 cases with this complication have been reported until now. Case presentation A 67-year-old Japanese man with a weight of 80 kg, height of 162.2 cm, and body mass index of 30.4 kg/m2 underwent three-port video-assisted thoracic surgery for lung cancer with one-lung ventilation. He had suffered from traumatic right rib fractures 6 weeks before the referral. Fifteen minutes before the end of the surgery, the systolic blood pressure suddenly dropped to about 50 mmHg, which was immediately recovered by intravenous injection of phenylephrine. This episode occurred during chest closure after the completion of the left upper lobectomy, and one-lung ventilation was soon switched to two-lung ventilation. Contralateral tension pneumothorax was noted by the postoperative chest x-ray. As the patient was complicated with obesity and a past history of rib fractures, increased airway pressure during one-lung ventilation related to obesity together with the persistent compression of the visceral pleura by the fractured ends of the ribs was considered to be the factors responsible for this critical complication. Conclusions Patient backgrounds such as obesity and past history of rib fractures should be noted carefully as risk factors for intraoperative contralateral pneumothorax during one-lung ventilation. We present the clinical course and discuss the mechanism of development of this potentially life-threatening complication in the present case with a review of the literature.

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