Nonoperative Management of Postintubation Tracheal Injuries

Bi-caval dual lumen venovenous extracorporeal membrane oxygenation and high-frequency percussive ventilatory support for postintubation tracheal injury and acute respiratory distress syndrome

“…Nonoperative management of postintubation tracheobronchial injuries in adults is becoming widely accepted for selected patients. Patients who may benefit from a nonoperative approach include those spontaneously breathing and those on mechanical ventilation who do not have clinical progression of air leak and respiratory insufficiency [8][9][10][11]. Given the location of our patient's injury, his size, his progressive ARDS, and his hemodynamic instability, anesthetic management and primary surgical repair would have been challenging.…”

Successful Conservative Management of Tracheal Injury After Forceful Coughing During Extubation: A Case Report

“…Conservative treatment consists of positioning the tracheal tube cuff distally to the lesion, i.e., a bridging maneuver (in order to keep the lesion under zero pressure and to prevent widening of the injury during inspiration), broad-spectrum antibiotics, and cough suppression (13). When treated optimally and avoiding steroid use, immunosuppression, and malnutrition, complete recovery can be achieved within one month (14). …”

Postintubation Tracheal Ruptures - A case report -

“…Consensus has not yet been reached on the management of PiTR [2,3,7-9]. Early surgical repair has traditionally been considered the cornerstone of therapy for PiTR [1,2,4-8,10].…”

“…For TBR that involve the distal third of the trachea or extend into the carina, selective main stem bronchus intubation has had a high rate of success. In all cases, ventilator settings should attempt to minimize high inspiratory pressures and tidal volumes to avoid exacerbating the tear [2,3,7,9]. Because of the risk of mediastinitis, wide-spectrum antibiotics should be administered for at least 1 week after the injury has been identified.…”