# Delayed Pneumothorax Following Bougie-Assisted Nasal Intubation

## TL;DR

A patient developed a delayed pneumothorax after a difficult nasal intubation, highlighting the need for continued monitoring post-procedure.

## Contribution

This case report highlights a rare delayed pneumothorax following bougie-assisted nasal intubation.

## Key findings

- A 45-year-old male developed a right pneumothorax several hours after nasal intubation.
- The pneumothorax was managed with a chest tube, leading to improved oxygen saturation and breathing.
- Delayed pneumothorax following intubation is rare, and its mechanism is often unknown.

## Abstract

A 45-year-old male with tongue cancer and obstructive sleep apnea presented for glossectomy and right neck dissection. He underwent a difficult nasal intubation assisted by a bougie and Glidescope. After an otherwise uneventful procedure, the patient was extubated and taken to recovery. Several hours later, he developed increased respirations and decreased oxygen (O2) saturation with decreased air movement on the right side of his chest. A chest X-ray confirmed a right pneumothorax. A chest tube was placed with immediate improvement of O2 saturation and breathing. Pneumothorax was presumably due to trauma from intubation. Although pneumothorax is a potential complication of intubation, it is more likely to occur shortly following intubation instead of hours later. The mechanism is often unknown. Providers must monitor patients throughout the perioperative period for any potential respiratory concerns, especially following a difficult intubation. This will ensure prompt diagnosis and management of any complications and provide an optimal outcome for the patient.