Post-extubation pneumothorax following bougie-assisted endotracheal tube exchange

We report a case of a young female patient with American Society of Anaesthesiologists Physical Status Class I who underwent functional endoscopic sinus surgery under routine general anaesthesia. After patient positioning, a sudden increase in peak airway pressures was noted, and kinking of the endotracheal tube (ETT) was observed. Bougie-assisted ETT exchange was performed. After an otherwise uneventful surgery, the patient was extubated and transferred to the post-anaesthesia care unit before being discharged to the ward. Several hours later she developed tachypnoea and tachycardia with a drop in oxygen saturation and decreased air entry on the right side of her chest. Radiological imaging confirmed a right pneumothorax. An intercostal chest drain was placed, which allowed for gradual re-expansion of the lung and clinical improvement. She was subsequently discharged from the hospital. Pneumothorax was presumed to be secondary to airway trauma during bougie-guided tube exchange.