{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T07:30:31Z","timestamp":1793345431432,"version":"4.5.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T00:00:00Z","timestamp":1630281600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T00:00:00Z","timestamp":1630281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Lung separation may be achieved through the use of double lumen tubes or endobronchial blockers. The use of lung separation techniques carries the risk of airway injuries which range from minor complications like postoperative hoarseness and sore throat to rare and potentially devastating tracheobronchial mucosal injuries like bronchus perforation or rupture. With few case reports to date, bronchial rupture with the use of endobronchial blockers is indeed an overlooked complication. <\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 78-year-old male patient with a left upper lobe lung adenocarcinoma underwent a left upper lobectomy with a Fuji Uniblocker\u00ae as the lung separation device. Despite an atraumatic insertion and endobronchial blocker balloon volume within manufacturer specifications, an intraoperative air leak developed, and the patient was found to have sustained a left mainstem bronchus rupture which was successfully repaired and the patient extubated uneventfully. Unfortunately, the patient passed on in-hospital from sepsis and other complications.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Bronchial rupture is a serious complication of endobronchial blocker use that can carry significant morbidity, and due care should be exercised in its use and placement. Bronchoscopy should be used during insertion, and the volume and pressure of the balloon kept to the minimum required to prevent air leak. Bronchial injury should be considered as a differential in the presence of an unexplained air leak.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12871-021-01430-6","type":"journal-article","created":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T08:16:54Z","timestamp":1630311414000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Bronchial rupture following endobronchial blocker placement: a case report of a rare, unfortunate complication"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9742-5600","authenticated-orcid":false,"given":"Shuwen","family":"Oo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel Hui Xuan","family":"Chia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hari Kumar","family":"Sampath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia Bee Leng","family":"Ang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh","family":"Paranjothy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Kit Chung","family":"Tam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Chuan Melvin","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,30]]},"reference":[{"issue":"3","key":"1430_CR1","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1097\/00000542-200609000-00009","volume":"105","author":"H Knoll","year":"2006","unstructured":"Knoll H, Ziegeler S, Schreiber JU, Buchinger H, Bialas P, Semyonov K, et al. Airway injuries after one-lung ventilation: a comparison between double-lumen tube and endobronchial blocker: a randomized, prospective, controlled trial. Anesthesiology. 2006;105(3):471\u20137.","journal-title":"Anesthesiology"},{"issue":"2","key":"1430_CR2","doi-asserted-by":"publisher","first-page":"184","DOI":"10.4097\/kja.d.18.00237","volume":"72","author":"JM van de Pas","year":"2019","unstructured":"van de Pas JM, van der Woude MC, Belgers HJ, Hulsew\u00e9 KW, de Loos ER. Bronchus perforation by EZ-BlockerTM endobronchial blocker during esophageal resection after neoadjuvant chemoradiation -a case report. Kor J Anesthesiol. 2019;72(2):184\u20137.","journal-title":"Kor J Anesthesiol"},{"issue":"3","key":"1430_CR3","doi-asserted-by":"publisher","first-page":"189","DOI":"10.4097\/kjae.2014.66.3.189","volume":"66","author":"JW Lee","year":"2014","unstructured":"Lee JW, Son JS, Choi JW, Han YJ, Lee JR. The comparison of the lengths and diameters of main bronchi measured from two-dimensional and three-dimensional images in the same patients. Kor J Anesthesiol. 2014;66(3):189\u201394.","journal-title":"Kor J Anesthesiol"},{"key":"1430_CR4","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1007\/s12630-012-9763-z","volume":"59","author":"M Sahin","year":"2012","unstructured":"Sahin M, Anglade D, Buchberger M, et al. Case reports: Iatrogenic bronchial rupture following the use of endotracheal tube introducers. Can J Anesth. 2012;59:963\u20137.","journal-title":"Can J Anesth"},{"issue":"2","key":"1430_CR5","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1053\/j.jvca.2004.01.003","volume":"18","author":"H Liu","year":"2004","unstructured":"Liu H, Jahr JS, Sullivan E, Waters PF. Tracheobronchial rupture after double-Lumen endotracheal intubation. J Cardiothorac Vasc Anesth. 2004;18(2):228\u201333.","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"5","key":"1430_CR6","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1510\/icvts.2008.196790","volume":"8","author":"T Schneider","year":"2009","unstructured":"Schneider T, Volz K, Dienemann H, Hoffmann H. Incidence and treatment modalities of tracheobronchial injuries in Germany. Interact Cardiovasc Thorac Surg. 2009;8(5):571\u20136.","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"6","key":"1430_CR7","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1016\/j.ejcts.2009.01.053","volume":"35","author":"E Mi\u00f1ambres","year":"2009","unstructured":"Mi\u00f1ambres E, Bur\u00f3n J, Ballesteros MA, Llorca J, Mu\u00f1oz P, Gonz\u00e1lez-Castro A. Tracheal rupture after endotracheal intubation: a literature systematic review. Eur J Cardiothorac Surg. 2009;35(6):1056\u201362.","journal-title":"Eur J Cardiothorac Surg"},{"issue":"5","key":"1430_CR8","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1016\/0003-4975(95)00643-Y","volume":"60","author":"CH Marty-An\u00e9","year":"1995","unstructured":"Marty-An\u00e9 CH, Picard E, Jonquet O, Mary H. Membranous tracheal rupture after endotracheal intubation. Ann Thorac Surg. 1995;60(5):1367\u201371.","journal-title":"Ann Thorac Surg"},{"issue":"6","key":"1430_CR9","doi-asserted-by":"publisher","first-page":"616","DOI":"10.4097\/kja.19161","volume":"72","author":"SY Parab","year":"2019","unstructured":"Parab SY. Comment on \"bronchus perforation by EZ-BlockerTM endobronchial blocker during esophageal resection after neoadjuvant chemoradiation\" Korean J Anesthesiol. 2019;72(6):616\u20137.","journal-title":"Korean J Anesthesiol"},{"issue":"4","key":"1430_CR10","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1016\/S1010-7940(02)00037-4","volume":"21","author":"HS Hofmann","year":"2002","unstructured":"Hofmann HS, Rettig G, Radke J, Neef H, Silber RE. Iatrogenic ruptures of the tracheobronchial tree. Eur J Cardiothorac Surg. 2002;21(4):649\u201352.","journal-title":"Eur J Cardiothorac Surg"},{"key":"1430_CR11","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1016\/0003-4975(96)00083-5","volume":"61","author":"G Massard","year":"1996","unstructured":"Massard G, Rouge C. Tracheobronchial lacerations after intubation and tracheostomy. Ann Thorac Surg. 1996;61:1483\u20137.","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"1430_CR12","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1177\/0310057X0403200117","volume":"32","author":"RR Jha","year":"2004","unstructured":"Jha RR, Mishra S, Bhatnagar S. Rupture of left main bronchus associated with radiotherapy-induced bronchial injury and use of a double-lumen tube in oesophageal cancer surgery. Anaesth Intensive Care. 2004;32(1):104\u20137.","journal-title":"Anaesth Intensive Care"},{"issue":"3","key":"1430_CR13","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1213\/01.ane.0000255171.94527.c7","volume":"104","author":"A Roscoe","year":"2007","unstructured":"Roscoe A, Kanellakos GW, McRae K, Slinger P. Pressures exerted by endobronchial devices. Anesth Analg. 2007;104(3):655\u20138.","journal-title":"Anesth Analg"},{"issue":"Suppl 1","key":"1430_CR14","doi-asserted-by":"publisher","first-page":"i92","DOI":"10.1093\/bja\/aew120","volume":"117","author":"M Carassiti","year":"2016","unstructured":"Carassiti M, Mattei A, Pizzo CM, Vallone N, Saccomandi P, Schena E. Bronchial blockers under pressure: in vitro model and ex vivo model. Br J Anaesth. 2016;117(Suppl 1):i92\u20136.","journal-title":"Br J Anaesth"},{"issue":"3","key":"1430_CR15","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1007\/s00540-011-1315-0","volume":"26","author":"T V\u00e9gh","year":"2012","unstructured":"V\u00e9gh T, Juh\u00e1sz M, Enyedi A, Tak\u00e1cs I, Koll\u00e1r J, F\u00fclesdi B. Clinical experience with a new endobrochial blocker: the EZ-blocker. J Anesth. 2012;26(3):375\u201380.","journal-title":"J Anesth"},{"issue":"6","key":"1430_CR16","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1213\/00000539-199906000-00012","volume":"88","author":"TB Gilbert","year":"1999","unstructured":"Gilbert TB, Goodsell CW, Krasna MJ. Bronchial rupture by a double-lumen endobronchial tube during staging thoracoscopy. Anesth Analg. 1999;88(6):1252\u20133.","journal-title":"Anesth Analg"},{"key":"1430_CR17","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1590\/S0034-70942005000600009","volume":"55","author":"RC BessaJ\u00fanior","year":"2005","unstructured":"BessaJ\u00fanior RC, Jorge JC, Eisenberg AF, et al. Ruptura br\u00f4nquica ap\u00f3s intuba\u00e7\u00e3o com tubo de duplo l\u00famen: relato de caso. Rev Bras Anestesiol. 2005;55:660\u20134.","journal-title":"Rev Bras Anestesiol"},{"key":"1430_CR18","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/524348","volume":"2013","author":"WR Hartman","year":"2013","unstructured":"Hartman WR, Brown M, Hannon J. Iatrogenic Left Main Bronchus Injury following Atraumatic Double Lumen Endotracheal Tube Placement. Case Rep Anesthesiol. 2013;2013. https:\/\/doi.org\/10.1155\/2013\/524348.","journal-title":"Case Rep Anesthesiol"}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-021-01430-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12871-021-01430-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-021-01430-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T08:18:07Z","timestamp":1630311487000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcanesthesiol.biomedcentral.com\/articles\/10.1186\/s12871-021-01430-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,30]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1430"],"URL":"https:\/\/doi.org\/10.1186\/s12871-021-01430-6","relation":{},"ISSN":["1471-2253"],"issn-type":[{"value":"1471-2253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,30]]},"assertion":[{"value":"14 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 August 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Exemption from ethics review was granted by the Institutional Review Board of the National Healthcare Group, Singapore.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written, signed informed consent for publication of clinical details and clinical images was obtained from the patient on postoperative day 1 after he was extubated. A copy of the written consent is available for review by the Editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"208"}}