Description:
A 53-year-old African-Caribbean male patient, with a background of
hypertension, tested positive for COVID-19 and was intubated and
ventilated on the intensive care unit. He had a classical COVID-19 chest
x-ray consisting of hazy consolidation and ground-glass opacification
bilaterally. During his admission, he developed an endotracheal tube
(ETT) cuff leak. The ETT exchange, done with a gum elastic bougie (GEB),
was challenging due to the high volume of thick secretions distorting
the view of the glottic inlet. As demonstrated, this difficulty caused a
significant right-sided pneumothorax with surgical emphysema secondary
to a pneumomediastinum, likely caused by the GEB. Additionally, there is
a degree of mediastinal shift, though this is difficult to assess due to
patient rotation. What is the immediate management? Ideally, such as in
this case, an emergency surgical chest drain should be inserted
concomitantly so as not to exacerbate the pneumothorax and cause
tensioning as well as further haemodynamic instability (Goswami &
Sarangi, 2016). The primary teaching point is the significant
consequences that can be caused by a GEB, and while a useful instrument
common to anesthetic practice, it should be used cautiously and safely.