Tracheal tube misplacement in the thoracic cavity: A case report

doi:10.12998/wjcc.v9.i34.10733

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Dec 6, 2021; 9(34): 10733-10737
Published online Dec 6, 2021. doi: 10.12998/wjcc.v9.i34.10733

Tracheal tube misplacement in the thoracic cavity: A case report

Ke-Xin Li, Yu-Ting Luo, Leng Zhou, Jia-Peng Huang, Peng Liang

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).

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
Processing time: 119 Days and 21 Hours

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.

Keywords: Penetrating neck injury; Tracheal injury; Endotracheal intubation; Malposition; Pneumothorax; Case report

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.