Management of tracheal trauma (original) (raw)
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Pathophysiology and management of Airway Trauma
Trends in Anaesthesia and Critical Care, 2013
Trauma to the larynx and tracheo-bronchial tree can result from blunt or penetrating injury and is associated with a high mortality despite improvement in emergency services. Prompt diagnosis of impending respiratory failure and securing the airway without causing further damage remains the first priority in patients with laryngotracheal injury. The technique used for securing the airway should be tailored according to the state of the patient, site of injury and available facilities. In addition to discussing the ideal airway management techniques that should be used in these patients, the paper provides an overview of the common airway management techniques that have previously been used and are reported in literature.
A review of traumatic airway injuries: Potential implications for airway assessment and management
Injury, 2007
Results: One hundred and four patients were identified as TAI in the study period (incidence of 0.4% for blunt and 4.5% for penetrating trauma). Sixty-eighty patients were victims of penetrating trauma (ISS: 24 AE 10; mortality: 16%). Thirty-six patients were blunt trauma victims (ISS: 33 AE 16; mortality: 36%). Overall, 65% of the patients received a definitive airway (DA) in the pre-hospital setting or at the initial hospital assessment. Alternative techniques for obtaining DA including wound tracheal tube, surgical airway and intubation under fiberoptic bronchoscopy were used in 30% of the patients. Among 24 deaths, 10 were considered primarily due to the airway injury. Twelve patients presented with thoracic TAI with nine deaths in this subgroup. Conclusions: Overall, the incidence of TAI is low. Blunt trauma TAI is less common, and these patients have a different clinical presentation, higher ISS and mortality than the penetrating TAI group. Early assessment of airways is crucial and DA was required in 2/3 of the patients with TAI. Lower airway injuries have higher mortality than upper airway injuries. Even though most patients died as a result of other injuries, causative factors of death included difficulty in obtaining DA and ventilation/oxygenation problems. #
Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment
Journal of Cardiothoracic Surgery, 2014
Airway injuries are life threatening conditions. A very little number of patients suffering air injuries are transferred live at the hospital. The diagnosis requires a high index of suspicion based on the presence of non-specific for these injuries symptoms and signs and a thorough knowledge of the mechanisms of injury. Bronchoscopy and chest computed tomography with MPR and 3D reconstruction of the airway represent the procedures of choice for the definitive diagnosis. Endotracheal intubation under bronchoscopic guidance is the key point to gain airway control and appropriate ventilation. Primary repair with direct suture or resection and an end to end anastomosis is the treatment of choice for patients suffering from tracheobronchial injuries (TBI). The surgical approach to the injured airway depends on its location. Selected patients, mainly with iatrogenic injuries, can be treated conservatively as long as the injury is small (<2 cm), a secure and patent airway and adequate ventilation are achieved, and there are no signs of sepsis. Patients with delayed presentation airway injuries should be referred for surgical treatment. Intraoperative evaluation of the viability of the lung parenchyma beyond the site of stenosis/obstruction is mandatory to avoid unnecessary lung resection.
Management of Laryngo Tracheal Injury Our Experience
MOJ Clinical & Medical Case Reports, 2016
Laryngotracheal trauma is life-threatening. It is considered to be a rare occurrence but now it is more common due to high speed vehicle accident. Failure to recognize such injuries and promptly secure an airway may have fatal consequences. 1 We are reporting 3 cases of blunt trauma following which they developed absolute dysphagia, difficulty in breathing and difficulty in phonation. These patients were promptly and appropriately managed. Two patients were surgically managed and one patient was conservatively managed. They are on regular follow up and are doing well. Here we highlight a successful management of such rare cases.
Traumatic injuries to the trachea and bronchi: a narrative review
Mediastinum, 2021
In this narrative review, we aim to provide a definition of traumatic tracheo-bronchial injuries as well as an approach to their diagnosis and management, including operative and non-operative strategies. Background: Traumatic tracheo-bronchial injuries are relatively uncommon, but are associated with a high mortality, both at the scene and among patients who survive to hospital. Management often requires an emergency airway, usually intubation over a flexible bronchoscope, followed by definitive repair. Methods: The published literature on the diagnosis and management of traumatic airway injuries was searched through PubMed. Additional references were identified from the bibliography of relevant publications identified. The evidence was then summarized in a narrative fashion, incorporating the authors' knowledge, experience, and perspective on the topic. Conclusions: Definitive diagnosis of traumatic tracheo-bronchial injuries usually involves direct visualization through liberal use of bronchoscopy in addition to cross-sectional imaging to evaluate for associated injuries, notably to the great vessels and esophagus. Important considerations for management include concerns for airway obstruction, uncontrolled air leak, and mediastinitis. Early repair of injuries recognized acutely is favored in attempts to prevent the development of airway stenosis. Key operative principles include exposure, conservative debridement to preserve length when possible, creation of a tension-free anastomosis, preservation of the blood supply, and creation of a tracheostomy, particularly in polytrauma patients. An interposition muscle flap is also required, specifically in the setting of combined esophageal and airway injuries. Patients with penetrating injuries tend to have more favorable outcomes, possibly on account of fewer concomitant injuries. Selective non-operative management is also an option in the subset of patients with iatrogenic injuries to the posterior membranous wall of the trachea, and includes broad-spectrum antibiotics and surveillance bronchoscopy.
Nonoperative Management of Tracheobronchial Injuries in Severely Injured Patients
Surgery Today, 2005
Purpose. A rupture of the airway due to blunt chest trauma is rare, and treatment can prove challenging. Many surgeons suggest operative management for these kinds of injuries. Nonoperative therapy is reported only in exceptional cases. But there is still a lack of evidence from which to recommend surgical repair of these injuries as the first choice procedure. Methods. We retrospectively analyzed the records of 92 multiple injured patients admitted to our trauma department between July 2002 and July 2003 for the incidence and management of tracheobronchial rupture (TBR). Results. Five (5.4%) of 92 patients suffered from tracheobronchial injuries. The mean injury severity score was 38. There were three male and two female patients, with a mean age of 23 years. All patients had lesions <2 cm in size and were treated nonoperatively. One patient died from multiorgan failure, but the others recovered from TBR uneventfully. One patient developed acute pneumonia as a result of respirator therapy, but none of the patients had mediastinitis or tracheal stenosis within 3 months after injury. Conclusion. We believe that surgical treatment is not mandatory in patients with small to moderate ruptures, and such aggressive treatment may even have adverse effects, especially in patients with multiple injuries.
Successful Management of Complete Tracheal Disruption after Blunt Trauma: A Case Report
Research and reviews: journal of medical and health sciences, 2013
We present here a case of 22 years old male who sustained road traffic accident, crushed between two vehicles, suffering complete transaction of the trachea extending from C7-D1 level to D3-4 level. Patient sought immediate medical assistance at the nearest medical centre with complaints of respiratory distress and subcutaneous emphysema; referred to a tertiary care hospital. Fibreoptic bronchoscopy was performed; airway was secured by placing the endotracheal tube tip distal to the distal tracheal disruption site. It was an interesting and challenging case, as patient had only airway trauma and no other injury. Surgical repair was done on 8th day of injury. Patient developed chest infections and septicemia, treated as per sepsis guidelines and using mechanical ventilation. He responded to treatment, recovered and was extubated on 40th day. Tracheal stenosis at the site of repair was observed on Fibreoptic bronchoscopy and CECT (Contrast enhanced computer tomography) chest.
2014
Airway injuries are life threatening conditions. A very little number of patients suffering air injuries are transferred live at the hospital. The diagnosis requires a high index of suspicion based on the presence of non-specific for these injuries symptoms and signs and a thorough knowledge of the mechanisms of injury. Bronchoscopy and chest computed tomography with MPR and 3D reconstruction of the airway represent the procedures of choice for the definitive diagnosis. Endotracheal intubation under bronchoscopic guidance is the key point to gain airway control and appropriate ventilation. Primary repair with direct suture or resection and an end to end anastomosis is the treatment of choice for patients suffering from tracheobronchial injuries (TBI). The surgical approach to the injured airway depends on its location. Selected patients, mainly with iatrogenic injuries, can be treated conservatively as long as the injury is small (<2 cm), a secure and patent airway and adequate v...
Tracheal and main bronchial disruptions after blunt chest trauma: Presentation and management
The Annals of Thoracic Surgery, 1990
Tracheobronchial disruption is one of the less common injuries associated with blunt thoracic trauma. This injury can be life threatening, however, and failure to diagnose it early can lead to disastrous acute or delayed complications. Nine cases of tracheobronchial disruption in the setting of nonpenetrating thoracic trauma were seen at four Los Angeles trauma centers between 1980 and 1987. Mechanism of injury, presentation, diagnosis, and management of these patients were reviewed. Disruptions involved the trachea in 3 patients, the right bronchus in 5 patients, and the left bronchus in 2 patients. Tracheobronchial disruptions occurred in sethe true incidence of tracheobronchial injuries in blunt T trauma is difficult to establish because many patients sustaining trauma severe enough to cause such injuries die before reaching the hospital [l]. Ecker and colleagues [2] reviewed tracheobronchial injuries over a 10-year period in Dallas County: of 27 patients with blunt tracheobronchial injuries (14 vehicular, 11 air crash, and 2 crush or fall related) only 9 (all of vehicular origin) were alive on reaching the emergency room. Bertelsen and Howitz [3], reviewing 1,178 postmortem reports of persons dying of trauma, reported that only 33 (0.03%) had tracheobronchial disruptions; 27 of them died almost immediately. Although rare, tracheobronchial injuries appear to be on the increase, associated with the increasing use of highspeed transportation [l].