Pneumothorax following bougie-guided intubation in a difficult airway: A report of two cases

Abstract

Patients coming for atlantoaxial dislocation surgery represent a unique subset of difficult intubation. In addition to having restricted neck movements, excessive movements at the neck joint during intubation must be avoided to avoid further compression. In view of the anticipated difficult intubation, adjuncts or introducers may be required to aid intubation, the most commonly used being bougies. Complications are known to occur with the use of bougies but fortunately the incidences are far and few. The most dreaded of these is pneumothorax, secondary to trauma by the bougie. The use of an adult bougie for pediatric intubations could possibly increase the risk of the same. Here, we report two incidences of pneumothorax after bougie-guided intubation.

Delayed Pneumothorax Following Bougie-Assisted Nasal Intubation

“…In addition, perforation of the trachea or bronchi can further lead to the development of a pneumothorax, which can be potentially detrimental. This was evidenced by several reported cases [2][3][4][5]14], all of which involved difficult intubations requiring bougie assistance.…”

“…Other potential causes include a tracheobronchial mucosal tear or perivascular alveolar rupture. In the reviewed case reports, both of these types of injuries led to immediate symptoms requiring treatment [ 2 , 4 , 5 ]. Therefore, they would not explain the delay in clinical presentation for the current case.…”

“…This is a case report of delayed pneumothorax after bougie-assisted nasal intubation in a patient undergoing a head and neck procedure. Although an uncommon occurrence, bougie has been linked to pneumothorax following intubation, particularly in difficult situations [2][3][4][5].…”