Cefalu John N, Williams Danielle C, Joshi Tejas V, Kaye Alan David
Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA.
Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
Ochsner J. 2020 Summer;20(2):222-225. doi: 10.31486/toj.18.0155.
Tension pneumothorax is a serious, potentially life-threatening condition with numerous etiologies. Hypopharyngeal injury, a possible complication of endotracheal intubation, can lead to tension pneumothorax. We describe a hypopharyngeal injury that occurred during endotracheal intubation that resulted in tension pneumothorax. A 30-year-old female underwent emergent chest tube placement after sustaining an intraoperative tension pneumothorax caused by pyriform sinus tract injury during traumatic intubation for an elective fistulectomy, debridement of a previous fracture site, and removal and replacement of hardware 4 months from the time of the initial injury. A timely chest x-ray aided in the discovery of the pneumothorax. Postoperatively, the patient's tension pneumothorax resolved, her chest tube was removed, and she was extubated during her stay in the trauma intensive care unit. The patient was discharged without any other major complications. Tension pneumothorax is a rare but reported complication that can occur during intubation and intraoperatively. Early recognition of hypopharyngeal perforation is crucial to successful management. Anticipation of a difficult airway can suggest the use of alternative methods of intubation that may reduce the risk of hypopharyngeal perforation.
张力性气胸是一种严重的、可能危及生命的疾病，病因众多。下咽损伤是气管插管可能出现的并发症，可导致张力性气胸。我们描述了一例气管插管过程中发生的下咽损伤导致张力性气胸的病例。一名30岁女性在择期瘘管切除术、既往骨折部位清创以及初次受伤4个月后取出并更换内固定装置的创伤性插管过程中，因梨状窦道损伤导致术中出现张力性气胸，随后接受了紧急胸腔闭式引流术。及时的胸部X光检查有助于发现气胸。术后，患者的张力性气胸得到缓解，胸腔闭式引流管被拔除，她在创伤重症监护病房住院期间拔管。患者出院时无任何其他重大并发症。张力性气胸是一种罕见但有报道的并发症，可发生在插管过程中和手术中。早期识别下咽穿孔对于成功治疗至关重要。预判困难气道可提示使用替代插管方法，这可能降低下咽穿孔的风险。
