Outcome of Tracheobronchial Injuries: A Long-Term Perspective

Richardson, J. David

doi:10.1097/01.ta.0000108631.72315.78

Cited by 54 publications

(39 citation statements)

References 8 publications

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“…in length, perforation into the pleural cavity, progressive subcutaneous or mediastinal emphysema and insufficient mechanical ventilation [1,2]. However, some authors stated that surgical repair should be preferred only if the lesion was detected during a thoracic surgical procedure or in patients inadequately ventilated with mechanical ventilation [1,13,15].…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Tracheal Ruptures: Review of the Literature and Personal Experience on 11 Cases

Aydemir¹,

Çelık²,

Uncu³

et al. 2013

OJTS

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Objective: Iatrogenic tracheal rupture is a rare, but life-threatening complication of orotracheal intubation. In this retrospective study, etiology, and diagnostic and therapeutic approaches for iatrogenic tracheal ruptures were reviewed. Method: Eleven patients (6 males and 5 females) were diagnosed and treated for iatrogenic tracheal rupture in our clinic. The laceration occurred after orotracheal intubation in 7 cases, and during percutaneous tracheostomy and emergency tracheostomy in the other four cases, respectively. Diagnosis was made during thoracic surgery in 5 cases. The remaining cases were diagnosed in the post-operative period; the most common symptoms were mediastinal and subcutenous emphysema and pneumothorax. Results: The diagnosis was confirmed by bronchoscopy in all cases. The lacerations were longitudinal, 1 -7 cm in length and were located in the distal membranous trachea. While ruptures detected intraoperatively were repaired during the surgery, the others were treated conservatively. No mortality was observed among cases treated surgically. However, three of the cases treated conservatively died (50%), and the cause of death was the underlying disease requiring intubation. Conclusion: We are in the opinion that primary disease is a determinant of patient outcome. Except cases identified during surgery, emergency surgical interventions should be preferred in patients, in whom ventilation cannot be achieved. On the other hand, bronchoscopic fibrin glue instillation should additively be applied to conservative treatment of tracheal lacerations.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic Tracheal Ruptures: Review of the Literature and Personal Experience on 11 Cases

Aydemir¹,

Çelık²,

Uncu³

et al. 2013

OJTS

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“…Surgical treatment has been reported by Cassada and coll. and Richardson in two series of 11 and 33 patients respectively [18,19]. Different mechanisms of rupture, leading to complex and irregularly shaped disruptions, with frequent involvement of major bronchi and, consequently, with higher incidence of complications, account for the minor role of the conservative measures in this setting [18][19].…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, a few cases and a few recent series have been reported with even wide full-thickness iatrogenic tracheal lacerations successfully managed by means of conservative treatment [10][11][12][13][14][15][16][17]. As far as traumatic ruptures are concerned, surgical treatment is advocated in most cases as well [18][19], but the conservative treatment has been reported also [20][21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Treatment of iatrogenic and traumatic tracheal disruptions

Leoncini¹,

Iurilli²,

Boni³

et al. 2016

Monaldi Arch Chest Dis

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Background and aim. The optimal management of tracheal disruptions is still controversial. It is usually postulated that lesions wider than 1 or 2 centimetres and/or lesions of full-thickness should be treated by surgery at an early stage. Such a statement is not supported by any proven evidence. On the contrary, the conservative management of such injuries has also produced very good results according to recent reports. The aim of this study is to investigate whether conservative treatment can be safely used for wide tracheal lacerations and to assess any possible association between clinical features and modality of treatment. Methods. Records of all patients with iatrogenic and traumatic tracheal disruptions observed between January 1992 and December 2006 were collected and retrospectively reviewed. Data regarding mechanism of injury, clinical and morphological features and modalities of treatment were registered. All possible associations between clinical features and modalities of treatment were investigated. Results. 23 patients were observed overall. There were 6 males and 17 females with a median age of 58 years (range 20-84 yrs). 15 patients had undergone single tube intubation. One patient had his trachea injured during an esophagectomy. Ruptures were secondary to blunt (n=5) and open (n=2) trauma in 7 patients. Lesions varied in length between 1 and 7 centimetres (median length 3 centimetres) and all were full-thickness. The time interval until diagnosis varied between 0 and 72 hours (median 6 hours). Respiratory failure was evident in 7 patients. 16 patients (69.5%) with lacerations ranging in length between 1 and 5.5 centimetres (median length 2.75 cm) underwent conservative treatment. Seven patients (30.5%) underwent surgery. The follow up was completed for 16 patients and varied between 15 and 105 months (median 22.5). One patient died after surgical treatment. No mortality or late major sequelae were registered after conservative treatment. Female sex, absence of respiratory failure and delayed diagnosis was associated with the conservative treatment. Conclusions. Conservative treatment can play a major role even in cases of wide tracheal lacerations. Clinical rather than morphological features should be regarded as main criteria for treatment. The conservative treatment is particularly indicated in the case of stable respiratory parameters independent of the size and the depth of the lesion.

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“…[11,12] Sıklıkla polipropilen daha az sıklıkla polidioksanon dikişler tercih edilmektedir. [13] Olgularımızın tamamına cerrahi tedavi uygulanmıştır. Sadece sağ üst lob ve orta lob bronşunda parçalı laserasyon görülen 1 olguya rezeksiyon uygulanmıştır (%11,1).…”

Section: şEkilunclassified

Tracheobronchial injuries

AYDEMİR¹

2011

Ulus Travma Acil Cerrahi Derg

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AMAÇBu çalışmada, trakeobronşiyal yaralanmaların tanı ve tedavisinde kullanılan yöntemleri araştırdık ve literatürle karşı-laştırmayı amaçladık. GEREÇ VE YÖNTEMKliniğimizde 2003-2008 yılları arasında trakeobronşiyal yaralanma nedeni ile ameliyat edilen 9 olgu (7 erkek, 2 kadın) çalışmaya dahil edildi. Travma sonrası trakeobronşi-yal yaralanma nedeni ile ameliyat edilen 7 olgu ile entü-basyon sonrası trakeal yaralanma görülen 2 olgu incelendi. Olgular, yaş, cinsiyet, travma tipi, klinik bulgular, yaralanma bölgesi, uygulanan girişim ve sonuçları açısından değerlendirildi. BULGULARYaralanma 6 olguda künt travma, 1 olguda penetran travma sonucu gerçekleşirken, 2 olguda ise iyatrojenikti. Yaralanma 5 olguda trakeal, 4 olguda ise bronşiyal seviyede idi. Bir olguya üst bilobektomi, bir olguya trakeal rezeksiyon ve ucuca anastamoz, 3 olguya uçuca anastomoz ve 4 olguya ise primer tamir yapıldı. Bir olgu ameliyat sırasında, bir olgu ise ameliyat sonrası erken dönemde kaybedildi. SONUÇTrakeobronşiyal yaralanmalarda erken tanı önemlidir. Yaralanmanın yerinin ve şeklini belirlenmesi için kullanılan en önemli tanı aracı bronkoskopidir. Tedavide rezeksiyondan mümkün olduğunca kaçınılmalı ve primer onarım tercih edilmelidir.

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Outcome of Tracheobronchial Injuries: A Long-Term Perspective

Cited by 54 publications

References 8 publications

Iatrogenic Tracheal Ruptures: Review of the Literature and Personal Experience on 11 Cases

Iatrogenic Tracheal Ruptures: Review of the Literature and Personal Experience on 11 Cases

Treatment of iatrogenic and traumatic tracheal disruptions

Tracheobronchial injuries

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