Treatment of the Left-sided Refractory Pneumothorax after Surgery for Esophageal Cancer by Differential Lung Ventilation Using a Double-lumen Endotracheal Tube for Tracheostomy

Abstract

  We performed a tracheostomy in a patient who developed right-sided pleural empyema and pneumonia after surgery for esophageal cancer. Although left-sided pneumothorax subsequently occurred, he was successfully treated with differential lung ventilation using a double-lumen endotracheal tube for the tracheostomy. When different pathological conditions exist in each lung, the unaffected lung will be hyperinflated when high-pressure ventilation is applied to improve oxygenation. This, in turn may result in pressure damage. For this reason, each lung should be ventilated under different conditions. However, when using a double-lumen endotracheal tube in tracheostomized patients over long periods, careful attention may be required to ensure the tube is fixed at the right position.