Li KX, Luo YT, Zhou L, Huang JP, Liang P. Tracheal tube misplacement in the thoracic cavity: A case report. World J Clin Cases 2021; 9(34): 10733-10737 [PMID: 35005009 DOI: 10.12998/wjcc.v9.i34.10733]
Corresponding Author of This Article
Peng Liang, MD, Associate Professor, Day Surgery Center, Department of Anesthesiology, West China Hospital, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan Province, China. liangpengwch@scu.edu.cn
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ke-Xin Li, Yu-Ting Luo, Leng Zhou, Department of Anesthesiology, West China Hospital, Chengdu 610041, Sichuan Province, China
Jia-Peng Huang, Department of Anesthesiology, University of Louisville, Louisville, KY 40202, United States
Peng Liang, Day Surgery Center, Department of Anesthesiology, West China Hospital, Chengdu 610041, Sichuan Province, China
Author contributions: Li KX, Luo YT, and Zhou L collected medical records of the patient; all authors were involved in the drafting and revision of this manuscript and approved the final version to be published.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Peng Liang, MD, Associate Professor, Day Surgery Center, Department of Anesthesiology, West China Hospital, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan Province, China. liangpengwch@scu.edu.cn
Received: August 2, 2021 Peer-review started: August 2, 2021 First decision: September 1, 2021 Revised: September 9, 2021 Accepted: October 18, 2021 Article in press: October 18, 2021 Published online: December 6, 2021
Abstract
BACKGROUND
Penetrating neck injuries require prompt recognition, diagnosis and management of critical airways. This case demonstrates an emergent situation that a “medical negligence” was avoided with the aid of end-tidal carbon dioxide (ETCO2) waveform.
CASE SUMMARY
We report a case of malposition of the endotracheal tube into the right hemithoracic cavity for cervical knife trauma, resulting in pneumothorax. Tube placement was not confirmed during emergency airway management, and the patient was directly transferred to the emergency operation room. Assisted by ETCO2 and imaging examinations, the anesthetist timely noticed the absence of ETCO2 waveform and resolved this urgent situation before anesthesia induction.
CONCLUSION
This case emphasizes the necessity of ETCO2 waveform and/or X-ray confirmation of endotracheal intubation even in emergent situations.
Core Tip: We report a case of malposition of the endotracheal tube into the right hemithoracic cavity for cervical knife trauma, resulting in pneumothorax. Fortunately, the anesthetist timely noticed the absence of end-tidal carbon dioxide (ETCO2) waveform and reviewed the thoracic computed tomography scanning just before anesthesia induction. This case highlights the role of ETCO2 waveform and/or chest radiography in confirmation of emergency endotracheal intubation, especially for junior doctors and emergency physicians.
