Left Lung Collapse and Right Tension Pneumothorax: A Tale of Endobronchial Intubation and Ventilation

Endobronchial intubation (EBI) is a relatively uncommon but well-recognized complication during anesthesia, often presenting with unexplained oxygen desaturation. Patient positioning or movement during anesthesia increases the risk for EBI. It causes lung collapse and may require intensive care therapy. The therapeutic intervention for EBI, namely, proper tube positioning and aggressive ventilation, can result in tension pneumothorax (TP), a correlation that is not reported in the literature. We report a case of EBI causing lung collapse and TP requiring unplanned admission to the intensive care unit. A young female patient was posted for craniotomy and excision of recurrent meningioma. Induction of anesthesia and intubation were uneventful. The procedure was performed in the supine position, and the patient developed oxygen desaturation at the end of surgery. It was realized by auscultation and flexible bronchoscopy that the desaturation was due to EBI and left lung collapse. The endotracheal tube was adjusted and ventilated with an Ambu bag with an improved tidal volume. Postoperatively, the patient remained in borderline oxygen saturation and developed hemodynamic instability requiring vasopressor. On chest point-of-care lung ultrasound (POCUS) examination, a right-sided pneumothorax was detected. Initially, needle decompression was done, followed by chest drain insertion. The patient was admitted to the intensive care unit (ICU), their hemodynamics gradually improved, and the chest drain was removed by day two of ICU admission. The patient was then transferred to the ward, from where he was later discharged home. EBI should be suspected in cases of perioperative desaturation. If a patient deteriorates further after tube repositioning, one should suspect pneumothorax and tension pneumothorax.