TENSION PNEUMOTHORAX AFTER TRACHEAL LACERATION DUE TO INTUBATION

Laceracija dušnika je rijetka, ali ozbiljna komplikacija koja se može javiti nakon endotrahealne intubacije. Pojavljuje se s incidencijom od 0,01 do 0,37 % ovisno o izvoru (1-4). Prikazujemo slučaj 61-godišnjeg bolesnika koji je primljen u jedinicu intenzivnog liječenja kirurških bolesnika u Kliniku za anesteziologiju, reanimatologiju i intenzivno liječenje Kliničkog bolničkog centra Zagreb nakon operacije karcinoma završnog dijela debelog crijeva. Bolesnik se pola sata nakon dolaska naglo klinički pogoršava uz sinus tahikardiju, hipotenziju, hipoksiju te abdominalnu distenziju. Ultrazvukom prsnog koša dokaže se tenzijski pneumotoraks koji se inicijalno zbrinjava perkutanom dekompresijskom iglom. Na rendgenogramu prsnog koša pokaže se pneumotoraks obostrano. Kompjuteriziranom tomografi jom prsnog koša se dodatno pokaže pneumomedijastinum i suspektna laceracija dušnika koja se na bronhoskopiji vidi kao blagi eritem sluznice. Pacijent je u jedinici intenzivnog liječenja proveo 4 dana, uz primjenu antibiotika širokog spektra i cijelo vrijeme boravka bio stabilan.Tracheal laceration is a rare but serious complication that can occur after endotracheal intubation. The incidence of tracheal laceration ranges from 0.01% to 0.37%. We present a case of a 61-year-old patient admitted to the Intensive Care Unit (ICU) of the Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Centre, after colon cancer surgery. The patient showed acute clinical aggravation, presented by sinus tachycardia, hypotension, hypoxia and abdominal distension half an hour upon arrival. Chest ultrasound showed tension pneumothorax initially treated by percutaneous decompression with a needle. Chest x-ray revealed two-sided pneumothorax. Computerized tomography of the thorax demonstrated pneumomediastinum and suspected laceration of the trachea that appeared on bronchoscopy as mild erythema of the mucous membrane. The patient was in the ICU for four days, where he was administered broad spectrum antibiotics and was stable throughout his stay