Conservative versus Surgical Management of Iatrogenic Tracheal Rupture

Abstract

Iatrogenic tracheal rupture (ITR) represents a life-threatening condition requiring prompt diagnosis, management, and treatment. The management of ITR is challenging, and treatment options depend on tear location, size, injury extent, and the patient's respiratory status. Although this complication has been extensively reported in published literature, the best evidence practice, for the management, requires clarification. In this review, the authors focused on the establishment of a differential diagnosis and the potential mechanism of the injury, the decision-making process, and the therapeutic approaches. It is suggested that for small lacerations or stable patients, conservative management could be considered sufficient, whereas invasive surgical therapy would be more appropriate in cases of large defects with significant air leak and patient instability.

Competence in pulmonary endoscopy emergencies

“…currently there is no unanimous consensus on the therapeutic management of iTi, [58][59][60][61][62] based on variability on clinical presentation and anatomy of the tracheal injury.…”

Tracheal Injury Prior to Sternotomy: A Cautionary Tale

“…Likely partly due to their rarity, long diagnostic delays are frequently described (up to 66%, with a range of 1-72 hours to diagnosis), increasing the morbidity and mortality. 8,14 Tracheal injuries in the setting of sternotomy have only rarely been reported, with only 8 other cases in the current literature to our knowledge. Of these, only one was secondary to electrocautery, 4 3 were from the sternal saw itself, 2-4 and 3 were of unconfirmed etiology after sternotomy.…”

“…12 Patients with proximal esophageal tumors status post neoadjuvant chemotherapy and radiation as well as patients with short, thick necks are high risk for tracheal injury during noncardiac procedures. 14 Iatrogenic tracheal laceration is reported in approximately 1/20,000 to 1/75,000 elective intubations with an overall reported incidence of 0.005% to 0.37% of intubations with a single lumen ETT and 0.05% to 1% of intubations with a double lumen ETT. 14 Of these, the incidence is higher by approximately 15% in those performed emergently.…”

Use of Venovenous Extracorporeal Membranous Oxygenation Following Iatrogenic Tracheal Rupture

“…Further studies should identify patients who will benefit from early surgical management and/or transfer to an ECMO-ready facility. 3 …”

“…1 Early recognition is important and diagnosis requires bronchoscopic confirmation. 2,3 We describe a case where emergent venovenous extra-corporeal membrane oxygenation (VV-ECMO) was utilized in the management of tracheal rupture.…”