ABSTRACT

When pneumothorax is suspected in a patient under anesthe-sia or awake, the diagnosis should be established immediately by taking the symptoms and physical examination findings into consideration and air should be aspirated without delay through the 2nd intercostal space on the midclavi-cular line.

A 2.5-year-old boy had undergone two tracheotomies at different times due to respiratory difficulties, and when his respiration improved he was de-cannulated, and one week later discharged from the hospital. The patient was admitted to our hospital with respiratory difficulties, and the diagnosis was es-tablished as subglottic stenosis. Therefore, a tracheotomy was performed. Early the next morning, the patient had respiratory difficulty and then tachypnea, tachycardia, cyanosis of the lips, and widespread subcutaneous emphysema in the cervical, thoracal, and abdominal areas were observed. Although the can-nula was replaced, ventilation with 100% O2 was performed, and steroid and theophylline were administered, SpO2 value did not rise above 72%. The pul-monary sounds were weaker on the left side than on the right, which suggested pneumothorax. Upon this finding, the intrapleural space was penetrated with a 16 G catheter on the left midclavicular line through the 2nd intercostal space, and approximately 30 cc of air was aspirated. One minute after this interventi-on, SpO2 value gradually rose as high as 96%.

Because of the decrease in life-threatening obstructive upper airway infections and the ongoing improvement in intensive care medicine, the role of tracheo-tomy in children has changed considerably. The incidence of pneumothorax following tracheotomy is reported to be 0% to 17%, depending on the age gro-up studied.