Management of Blunt Pulmonary Injury

Gallagher, John J.

doi:10.1097/nci.0000000000000059

Cited by 5 publications

(16 citation statements)

References 82 publications

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“…In generally the membranous part of the trachea is the weakest point and most likely for disruption, compared with the anterior and lateral wall which are strengthen by the U-shaped tracheal rings. Therefore, the anterior trachea is mostly injured in penetrating injuries, while the posterior wall is mainly affected in blunt traumas [4] .…”

Section: Location Size and Classification Of Tbimentioning

confidence: 99%

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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: Location Size and Classification Of Tbimentioning

confidence: 99%

“…Treatment of airway injuries should be individualized at every patient, considering comorbidities, location of the lesion and clinical presentation [4] . After safe airway management and necessary diagnostic steps, the patient should be transferred to the operating room for reconstruction as soon as possible.…”

Section: Surgical Managementmentioning

confidence: 99%

Contemporary management strategies of blunt tracheobronchial injuries

Rieth

Barootchi

Kovács

et al. 2021

Injury

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“…Monitoring of peak and Pplts, lung compliance, and radiographic findings may guide decisions to convert to whole lung ventilation and further ventilation liberation. [ 15 ] Surgical closure is usually necessary in unresponsive cases. [ 16 ] In a case series by Hurst et al ., ILV was initiated for 8 patients with pulmonary contusion with significant improvements in PaO 2 and shunt fraction with seven patients surviving.…”

Section: Discussionmentioning

confidence: 99%

Chest trauma: A case for single lung ventilation

Pandharikar¹

2016

Indian Journal of Critical Care Medicine

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Chest trauma is one of the important causes of mortality and morbidity in pediatric trauma patients. The complexity, magnitude, and type of lung injury make it extremely challenging to provide optimal oxygenation and ventilation while protecting the lung from further injury due to mechanical ventilation. Independent lung ventilation is used sporadically in these patients who do not respond to these conventional ventilatory strategies using double-lumen endotracheal tubes, bronchial blocker balloons, etc. However, this equipment may not be easily available in developing countries, especially for pediatric patients. Here, we present a case of severe chest trauma with pulmonary contusion, flail chest, and bronchopleural fistula, who did not respond to conventional lung protective strategies. She was successfully managed with bronchoscopy-guided unilateral placement of conventional endotracheal tube followed by single lung ventilation leading to resolution of a chest injury.

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“…Blunt chest trauma and hemorrhagic shock (T/HS) occurs in patients with poly-trauma (possibly following vehicular accidents) and is a leading risk factor in the development of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) (1,2). T/HS exhibits high morbidity and mortality rates (3,4). Furthermore, it is well known that apoptosis is involved in distinct types of ALI.…”

Section: Introductionmentioning

confidence: 99%

Penehyclidine hydrochloride exerts protective effects in rats with acute lung injury via the Fas/FasL signaling pathway

Kong

Duan

et al. 2019

Exp Ther Med

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Acute lung injury (ALI) is a critical syndrome that is associated with high morbidity and mortality rates. The activation of the Fas/Fas ligand (FasL) signaling pathway may be an important pathophysiological mechanism during ALI development. Penehyclidine hydrochloride (PHC) has been revealed to exhibit anti-apoptotic properties and may attenuate the observed systemic inflammatory response. The present study was performed to elucidate the molecular mechanism of PHC in the regulation of the Fas/FasL signaling pathway in rats with ALI. An ALI rat model was constructed by inducing blunt chest trauma and hemorrhagic shock (T/HS), with PHC administration prior to or following T/HS. At 6 h following T/HS, blood samples and lung tissues were collected. Western blotting, arterial blood gas analysis, ELISA, hematoxylin and eosin staining, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling staining and biochemical indicator analysis were performed to determine the degree of lung injury and the key signaling pathways associated with lung damage. The results indicated that the administration of PHC following T/HS effectively attenuates lung injury by improving pulmonary oxygenation, decreasing histopathological damage, decreasing polymorphonuclear neutrophil count and decreasing Fas, FasL, caspase-8, caspase-3, tumor necrosis factor-α, interleukin (IL)-6 and IL-1β expression. The results indicated that PHC exhibits anti-apoptotic functions and exerts protective effects in ALI rats induced by T/HS, which may be attributed to the inhibition of the Fas/FasL signaling pathway.

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Management of Blunt Pulmonary Injury

Cited by 5 publications

References 82 publications

Contemporary management strategies of blunt tracheobronchial injuries

Contemporary management strategies of blunt tracheobronchial injuries

Chest trauma: A case for single lung ventilation

Penehyclidine hydrochloride exerts protective effects in rats with acute lung injury via the Fas/FasL signaling pathway

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