Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942005000600009
Brazilian Journal of Anesthesiology
Clinical Information

Ruptura brônquica após intubação com tubo de duplo lúmen: relato de caso

Bronchial rupture after intubation with double lumen endotracheal tube: case report

Roberto Cardoso Bessa Júnior; Jaci Custódio Jorge; Agnaldo Ferreira Eisenberg; Wallace Lage Duarte; Márcio Sérgio Carvalho Silva

http://dx.doi.org/10.1590/S0034-70942005000600009 Braz J Anesthesiol, vol.55, n6, p.660-664, 2005
PDF Português
PDF English
Downloads: 1
Views: 1099

Resumo

JUSTIFICATIVA E OBJETIVOS: As lesões da árvore traqueobrônquica são complicações raras, porém graves após intubação ou broncoscopia. O objetivo deste relato foi chamar a atenção sobre a dificuldade de intubação seletiva que ocasionou ruptura brônquica associada a pneumomediastino e pneumotórax hipertensivo, com deformações de vias aéreas e óbito por resposta inflamatória sistêmica. RELATO DO CASO: Paciente do sexo masculino, 50 anos, portador de fístula broncopleural secundária à ruptura de bolha no lobo superior de pulmão direito. Após a indução anestésica, houve dificuldade na intubação endobrônquica esquerda. Na terceira tentativa, desenvolveu quadro de hipoxemia, hipotensão e enfisema subcutâneo extenso, sendo submetido à drenagem torácica por pneumotórax hipertensivo. A fibrobroncoscopia mostrou laceração do brônquio esquerdo. Evoluiu com hemoptise, sendo necessária toracotomia esquerda para sutura de laceração brônquica. No pós-operatório, o paciente desenvolveu quadro de disfunção de múltiplos órgãos, evoluindo para óbito. CONCLUSÕES: A intubação seletiva é um procedimento que deve ser realizado com cautela, sendo necessário o reconhecimento de alguns fatores de risco e o diagnóstico precoce das complicações.

Palavras-chave

COMPLICAÇÕES, EQUIPAMENTOS

Abstract

BACKGROUND AND OBJECTIVES: Tracheobronchial tree injuries are uncommon however severe complications after intubation or bronchoscopy. This report aimed at calling the attention to the difficult selective intubation, which has led to bronchial rupture associated to pneumomediastinum and hypertensive pneumothorax, with airway deformation and death by systemic inflammatory response. CASE REPORT: Male patient, 50 years old, with bronchopleural fistula secondary to bulla rupture in right lung upper lobe. After anesthetic induction it was difficult to intubate left bronchus. At the third attempt, patient developed hypoxemia, hypotension and extensive subcutaneous emphysema, being submitted to thoracic drainage for hypertensive pneumothorax. Fibrobronchoscopy has revealed left bronchus laceration. Patient evolved with hemoptysis, and left thoracotomy was necessary to suture bronchial laceration. Patient developed postoperative multiple organs dysfunction and evolved to death. CONCLUSIONS: Selective intubation is a procedure to be carefully performed, being necessary the understanding of some risk factors and the early diagnosis of complications.

Keywords

COMPLICATIONS, EQUIPMENTS

References

Liu H, Jahr JS, Sullivan E. Tracheobronchial rupture after double-lumen endotracheal intubation. J Cardiothorac Vasc Anesth. 2004;18:228-233.

Chen EH, Logman ZM, Glass PS. A case of tracheal injury after emergent endotracheal intubation: a review of the literature and causalities. Anesth Analg. 2001;93:1270-1271.

Kaloud H, Smolle-Juettner FM, Prause G. Iatrogenic ruptures of the tracheobronchial tree. Chest. 1997;112:774-748.

Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984;39:1105-1111.

Fitzmaurice BG, Brodsky JB. Airway rupture from double-lumen tubes. J Cardiothorac Vasc Anesth. 1999;13:322-329.

Guernelli N, Bragaglia R, Briccoli A. Tracheobronchial ruptures due to cuffed Carlens tubes. Ann Thorac Surg. 1979;28:66-67.

Gilbert TB, Goodsell CW, Krasna MJ. Bronchial rupture by a double-lumen endobronchial tube during staging thoracoscopy. Anesth Analg. 1999;88:1252-1253.

Clapham MC, Vaughan RS. Bronchial intubation: A comparison between polyvinyl choride and red rubber double lumen tubes. Anaesthesia. 1985;40:1111-1114.

Yuceyar L, Kaynak K, Canturk E. Bronchial rupture with a left-sided polyvinylchoride double-lumen tube. Acta Anaesthesiol Scand. 2003;47:622-625.

Brodsky JB, Lemmens HJ. Left double-lumen tubes: clinical experience with 1,170 patients. J Cardiothorac Vasc Anesth. 2003;17:289-298.

Lieberman D, Littleford J, Horan T. Placement of left double-lumen endobronchial tubes with or without a stylet. Can J Anaesth. 1996;43:238-242.

Seitz PA, Gravenstein N. Endobronchial rupture from endotracheal reintubation with an endotracheal tube guide. J Clin Anesth. 1989;1:214-217.

5dd6cf200e8825fb6213f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections