{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:55:35Z","timestamp":1760147735107,"version":"build-2065373602"},"reference-count":18,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,25]],"date-time":"2023-02-25T00:00:00Z","timestamp":1677283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Tension pneumothorax is a relatively rare complication after anesthetic induction that requires prompt diagnosis and treatment. Several handling errors related to intubation procedures or equipment and vigorous positive pressure ventilation are potentially important etiologies of tension pneumothorax in patients with underlying lung disease or in mechanically ventilated patients. We describe a case of tension pneumothorax observed after double-lumen tube (DLT) insertion followed by single-lumen tube replacement using an airway exchanger catheter in a mechanically ventilated patient. An 84-year-old female on mechanical ventilation underwent minimally invasive cardiac surgery under general anesthesia. Immediately after left-sided DLT insertion using an airway exchanger catheter, oxygen saturation decreased to 89%, peak airway pressure increased to 35 cm H2O with inadequate tidal volume, and blood pressure gradually dropped to 69\/41 mmHg. Breath sounds from the right hemithorax were significantly reduced. Severe collapse of the right lung, a flattened diaphragm, and compressed abdominal organs were identified on chest radiography. Therefore, a tube thoracotomy was performed based on the findings of a tension pneumothorax. Then, oxygen saturation, peak airway pressure with adequate tidal volume, and blood pressure improved, and the distended abdomen normalized. After the pneumothorax resolved, a bronchoscopy was performed. Slight redness was noted in the right bronchus, indicating that the DLT was incorrectly inserted into the right side. In conclusion, the possibility of a tension pneumothorax should be considered during DLT intubation or endotracheal tube replacement with an airway exchange catheter.<\/jats:p>","DOI":"10.3390\/medicina59030460","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T03:29:48Z","timestamp":1677468588000},"page":"460","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Unexpected Tension Pneumothorax after Double-Lumen Endotracheal Intubation in Patients with Pulmonary Edema: A Case Report"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4007-770X","authenticated-orcid":false,"given":"Jongyoon","family":"Baek","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang Jin","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Myungjin","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5758-6741","authenticated-orcid":false,"given":"Eun Kyung","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.5492\/wjccm.v3.i1.8","article-title":"Iatrogenic pneumothorax related to mechanical ventilation","volume":"3","author":"Hsu","year":"2014","journal-title":"World J. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1177\/0310057X1103900621","article-title":"Surgical tension pneumothorax during laparoscopic repair of massive hiatus hernia: A different situation requiring different management","volume":"39","author":"Phillips","year":"2011","journal-title":"Anaesth. Intensiv. Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1056\/NEJMoa1500964","article-title":"Intravascular complications of central venous catheterization by insertion site","volume":"373","author":"Parienti","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_4","first-page":"5017082","article-title":"Unexpected tension pneumothorax-hemothorax during induction of general anaesthesia","volume":"2019","author":"Amaniti","year":"2019","journal-title":"Case Rep. Anesthesiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1097\/00000542-199112000-00002","article-title":"Adverse respiratory events infrequently leading to malpractice suits. A closed claims analysis","volume":"75","author":"Cheney","year":"1991","journal-title":"Anesthesiology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1053\/j.jvca.2004.01.003","article-title":"Tracheobronchial rupture after double-lumen endotracheal intubation","volume":"18","author":"Liu","year":"2004","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_7","first-page":"503","article-title":"Tension pneumothorax complicated by double-lumen endotracheal tube intubation","volume":"28","author":"Huang","year":"2005","journal-title":"Chang Gung Med. J."},{"key":"ref_8","first-page":"861","article-title":"Tracheal diameter predicts double-lumen tube size: A method for selecting left double-lumen tubes","volume":"82","author":"Brodsky","year":"1996","journal-title":"Anesth. Analg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/S1053-0770(99)90291-4","article-title":"Prediction of double-lumen tracheal tube depth","volume":"13","author":"Bahk","year":"1999","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1007\/s00134-001-1178-1","article-title":"Relationship between ventilatory settings and barotrauma in the acute respiratory distress syndrome","volume":"28","author":"Boussarsar","year":"2002","journal-title":"Intensiv. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/BF03015965","article-title":"The use of an endotracheal ventilation catheter in the management of difficult extubations","volume":"43","author":"Cooper","year":"1996","journal-title":"Can. J. Anaesth."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1007\/s12630-011-9488-4","article-title":"Brief review: Supplementing oxygen through an airway exchange catheter: Efficacy, complications, and recommendations","volume":"58","author":"Duggan","year":"2011","journal-title":"Can. J. Anaesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1097\/00000542-199908000-00005","article-title":"Airway exchange catheters: Simple concept, potentially great danger","volume":"91","author":"Benumof","year":"1999","journal-title":"Anesthesiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/S0952-8180(02)00355-0","article-title":"Airway length in adults: Estimation of the optimal endotracheal tube length for orotracheal intubation","volume":"14","author":"Cherng","year":"2002","journal-title":"Can. J. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/ACO.0b013e3280111e2a","article-title":"Which device should be considered the best for lung isolation: Double-lumen endotracheal tube versus bronchial blockers","volume":"20","author":"Campos","year":"2007","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/imi.0b013e3182167feb","article-title":"Minimally invasive versus conventional open mitral valve surgery: A meta-analysis and systematic review","volume":"6","author":"Cheng","year":"2011","journal-title":"Innovations (Phila)"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.21037\/jtd-20-1804","article-title":"Anesthesia for minimally invasive cardiac surgery","volume":"13","author":"White","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e80","DOI":"10.2459\/JCM.0000000000000588","article-title":"Mitral valve repair versus MitraClip","volume":"19","author":"Settimio","year":"2018","journal-title":"J. Cardiovasc. 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