Blunt Tracheobronchial Trauma

Shemmeri, Ealaf; Vallières, Eric

doi:10.1016/j.thorsurg.2018.04.008

Cited by 20 publications

(43 citation statements)

References 22 publications

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“…Self-expanding metallic stent (SEMS) can be used as alternative treatment in patients who have high surgical risk or severe comorbidities. This novel method is also useful in case of late stenosis caused by granulation tissue at the site of laceration [12] .…”

Section: Non-surgical Managementmentioning

confidence: 99%

Contemporary management strategies of blunt tracheobronchial injuries

Rieth

Barootchi

Kovács

et al. 2021

Injury

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Background: Tracheobronchial injuries are rare but feasibly life-threatening conditions. A prompt diagnosis and early management can be lifesaving. Due to the unspecific symptoms and indirect radiological signs the diagnosis often delays.Objectives: We present a short series of patients suffering from tracheobronchial airway laceration. All the three patients had blunt thoracic or neck trauma and showed early signs of tracheobronchial injury. In the first case a 44-year-old woman was crushed by a bus. Subcutaneous emphysema, pneumothorax on chest computed tomography and hypoxaemia despite of chest tube suggested the presence of an airway injury. During operation a 4-cm-long tear of the trachea and a complete transection of the right main bronchus were found. In the second case a 12-year-old girl was crossed by a truck trailer. Early signs were respiratory failure, extended subcutaneous emphysema, blood clot in the larynx, pneumothorax on both sides. Chest CT showed pneumomediastinum. During the operation a longitudinal laceration was found separating the two main bronchi at the bifurcation. In the third case a 9-year-old boy was injured in a car accident, when the seat-belt crossed his neck. Spreading subcutaneous emphysema, pneumomediastinum and an overinflated endotracheal tube's cuff were found on CT. A completely transected trachea between the first and second tracheal rings was found. All three patients required fast intubation and bronchoscopic examination to confirm the diagnosis, and to identify the site of lacerations. All the patients underwent primary reconstruction and recovered successfully. Conclusions:In case of suspected tracheobronchial injury, a high index of suspicion is required for early diagnosis. Most commonly respiratory distress, subcutaneous emphysema and pneumothorax are found on physical examination. Prompt intubation below the site of the injury and early laryngo-or bronchoscopic examination have priority, as we did in our cases. A primary anastomosis is required with minimal resection during urgent operation. A better outcome is to be expected when extubation is done early after surgery. We offer ordinal steps that should be taken to lead to a prompt management and good long-term outcome based on the literature and our experiences.

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Section: Non-surgical Managementmentioning

confidence: 99%

Contemporary management strategies of blunt tracheobronchial injuries

Rieth

Barootchi

Kovács

et al. 2021

Injury

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“…Conservative treatment of post-traumatic airway lesions with fibrin glue and tracheal or bronchial stents has been described [21,46,47,54]. Self-expanding metallic stents are preferred by some authors since they more easily adapt to the shape of the tracheobronchial tree and more effectively seal the lesion, but care has to be taken to appropriately select the correct stent size to avoid enlargement of the injury [55][56][57]. Moreover, stent removal after healing may be rather demanding.…”

Section: Endoscopic Treatmentmentioning

confidence: 99%

Diagnostic and therapeutic approach to post-traumatic tracheobronchial injuries

2021

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Post-traumatic tracheobronchial lesions are associated with high mortality unless adequately diagnosed and treated. They may be caused by blunt and penetrating trauma, although iatrogenic lesions are also increasingly observed. An early and accurate diagnosis significantly impacts the results of treatment. Radiological assessment with computed tomography is highly accurate, but bronchoscopy remains the gold standard technique in the diagnosis of airway trauma and plays an important role in determining the therapeutic approach. For a long time, surgery has been considered the treatment of choice for post-traumatic airway lesions, but recent reports have shown that favourable results may also be obtained with a conservative approach, especially in the treatment of iatrogenic lesions. The indication for a conservative or surgical treatment has to be defined on the basis of a thorough clinical, radiological, and endoscopic assessment. Specific issues concerning airway management in the emergency setting and during surgical treatment must also be addressed. A multidisciplinary approach in a center with specific experience in the treatment of airway lesions is of utmost importance to obtain favourable results.

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“…Azoknak a betegeknek, akik számára a műtét túl kockázatos, alternatív kezelési módszer lehet sztent behelyezése. Ez a technika elsősorban szintén iatrogén esetekben ajánlott, illetve jó eredményeket értek el a légcsősérülések következményeként kialakuló szűkületek kezelésében [19]. Instabil, kritikus állapotú betegekkel kapcsolatban az elmúlt években egyre nagyobb számban publikálnak jó tapasztalatokat ECMO-(extracorporeal membrane oxygenation) kezeléssel [20].…”

Section: Esetismertetésunclassified

A túlfújt endotrachealis mandzsetta szerepe a légcsősérülések diagnosztikájában

et al. 2020

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Absztrakt: A tracheobronchialis sérülések ritkák, de életveszélyes állapotot jelenthetnek. Leggyakoribb okaik a nyaki vagy mellkasi, nagy energiájú tompa trauma, a nehéz intubálás vagy az intratrachealis tubus és gyomorszonda együttes viselése. A korai diagnózis és a megfelelő kezelés életmentő lehet, e sérülések felismerése azonban az atípusos tünetek és a súlyos társsérülések miatt gyakran elhúzódik. Típusos esetekben a fizikális vizsgálat során progresszív, kiterjedt subcutan emphysema hívhatja fel rájuk a figyelmet. További nehézséget jelent, hogy a radiológiai jelek nem elég specifikusak, a komputertomográfiás felvételeken pedig a leggyakrabban csupán subcutan emphysema, pneumomediastinum vagy esetenként pneumothorax látható. Cikkünkben három eset kapcsán mutatjuk be a tracheobronchialis sérüléseket – egy baleseti, egy nehéz intubációs légúti sérülés, illetve egy tracheooesophagealis fistula kialakulása során. Az endotrachealis tubus ballonja a tracheafal rupturája mentén mindegyik esetben túlfújhatóvá vált, így a légút falán kívülre terjedt – ez a képalkotó vizsgálatokon láthatóvá is vált. Ez egy ritka, de direkt és egyértelmű jele a légúti sérüléseknek, mely alapján a trachea teljes falvastagságának szakadására lehet számítani. Cikkünkben a túlfújt ballon diagnosztikus jelentőségére szeretnénk rávilágítani. Orv Hetil. 2020; 161(25): 1063–1068.

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Blunt Tracheobronchial Trauma

Cited by 20 publications

References 22 publications

Contemporary management strategies of blunt tracheobronchial injuries

Contemporary management strategies of blunt tracheobronchial injuries

Diagnostic and therapeutic approach to post-traumatic tracheobronchial injuries

A túlfújt endotrachealis mandzsetta szerepe a légcsősérülések diagnosztikájában

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