Iatrogenic injuries to the trachea and main bronchi

Abstract

IntroductionIatrogenic tracheobronchial injuries are rare.AimTo analyse the mechanism of injury, symptoms and treatment of these patients.Material and methodsRetrospective analysis of hospital records of all patients treated for main airway injuries between 1990 and 2012 was performed.ResultsThere were 24 patients, including 21 women and 3 men. Mean time between injury and initiation of treatment was 12 hours (range: 2-48). In 16 patients the injury occurred during tracheal intubation, in 1 during rigid bronchoscopy, in 1 during rigid oesophagoscopy, in 1 during mediastinoscopy and in 5 during open surgery. Mean length of airway tear was 3.8 cm (range: 1.5-8). In 1 patient there was an injury to the cervical trachea and in the remaining 23 in the thoracic part of the airway. The treatment included repair of the membranous part of the trachea performed via right thoracotomy in 10 patients (in 1 patient additionally coverage with a pedicled intercostal muscle flap was used), a self-expanding metallic stent in 1 patient, suture of the right main bronchus and the oesophagus in 1, left upper sleeve lobectomy in 1, right upper lobectomy in 1, implantation of a silicone Y stent in 3, mini-tracheostomy in 1, and conservative treatment in 5 patients.ConclusionsIntubation is the most frequent cause of iatrogenic main airway injuries. Patients with these life-threatening complications require an individualised approach and treatment in a reference centre.

Treatment of Tracheobronchial Injuries

“…13 Other causes of tracheobronchial injury include intrathoracic, esophageal, and head and neck surgical interventions including mediastinoscopy. [14][15][16] Tracheo-esophageal fistula as an intermediate or late complication of open surgical tracheostomy may occur due to incidental intraprocedural damage to the posterior tracheal wall. 17 For esophageal surgeries requiring combined intrathoracic and intraabdominal approaches airway injury occurs in approximately 1% to 1.8% of cases.…”

Anesthetic consideration for airway management of patients undergoing endoscopic fibrin glue treatment of tracheobronchial rupture: a case series of three patients

“…Seven patients (7/16) presented lesions in the upper half of the trachea, 9 patients (9/16) in the lower half, and in particular 4 in the right main bronchus and 2 in the left main bronchus. Only 3 patients presented lesions due to urgent intubation; all the rest (13) were complication of elective surgery and intubation (Gil et al 2016). Moreover, in the same study, 12 patients had an inferior to 3-cm-long lesion, 10 patients had a lesion that extended from 3 to 5 cm, and 2 patients an above 8-cm-length lesion.…”

“…Most iatrogenic tracheobronchial lesions are due to tracheal intubation. Other rarer causes are percutaneous tracheostomy, lesions related to stiff bronchoscopy, mechanical ventilation, thyroid surgery, esophageal surgery, and lung surgery (Gil et al 2016). A team approach to tracheal rupture intervention that involves the thoracic surgeon intensivist/anesthesiologist is very important.…”

Clinical analysis of eight patients with blunt main stem bronchial injuries

“…Bronchoscopy is crucial to the precise diagnosis of blunt main stem bronchial injuries in a patient with suspected airway injury, which can show the detail of injury, such as size, site and extent (4). The first and most important priority in blunt main stem bronchial injuries is to ensure adequate airway, and surgical approach is the preferred method for ventilation reestablishment.…”