Survival after traumatic complete laryngotracheal transection

Pace, Valerio; Macía, Iván; Rivas, Francisco; Ureña, Anna; Ramos, Ricard; Morera, Ricardo; Saumench, J.; Escobar, Ignacio; Villalonga, R.; Moya, Juan

doi:10.1016/j.ajem.2008.01.031

Cited by 12 publications

(6 citation statements)

References 4 publications

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“…In blunt trauma, approximately 80% of tracheobronchial lacerations occur near the carina at the distal trachea, typically in the posterior trachea wall due to lack of cartilaginous support [6]. Tracheal wall laceration from the first rib is a rare complication of blunt chest trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Tracheobronchial lacerations could be caused by blunt trauma, penetrating trauma or iatrogenic injuries from emergency intubations, multiple intubation attempts, and over-inflation of the tracheal cuff [1, 5]. Acute traumatic tracheal injury is rare to be seen by anesthesiologists because tracheobronchial lacerations usually result in acute airway obstruction and death at the scene of an accident or crime [6]. In recent years, more patients with tracheobronchial lacerations presented to the emergency department due to better pre-hospital evacuation procedures and heightened trainings [4].…”

Section: Introductionmentioning

confidence: 99%

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Anesthetic management of tracheal laceration from traumatic dislocation of the first rib: a case report and literature of the review

et al. 2019

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Background Tracheobronchial lacerations from trauma can be life-threatening and present significant challenges for safe anesthetic management. Early recognition of tracheal injuries and prompt airway control can be lifesaving. Case presentation A 56-year-old man with no significant medical history presented with difficulty breathing after a blunt trauma to his chest to the emergency room and was diagnosed with dislocation of the first rib and tracheal laceration after a chest tomography (CT) study. Subcutaneous emphysema in neck area quickly worsened indicating continuous air leak. Emergent surgical repair was scheduled. General anesthesia with maintaining spontaneous ventilation was performed and a 5.5 mm endotracheal tube was placed under the guidance of flexible bronchoscopy. Depth of anesthesia was maintained to achieve a Bispectral Index Score of 40–60. Once the offending first rib was removed, a 7.5 mm endotracheal tube was inserted distal to the laceration site with the guidance of flexible bronchoscopy. Once confirmed location of the endotracheal tube, cisatracurium was administered intravenously and the patient was managed on mechanical ventilation with interval positive pressure ventilation. The operation was successful and he was transferred to the ICU intubated. He then received elective surgical repairs for sternum fracture, multiple rib fractures and hemopneumothorax under general anesthesia on day 5 after the first surgery and was extubated on postoperative day 7. The subsequent course was uneventful. Comprehensive rehabilitation was done for 2 weeks and he was discharged home on postoperative day 41. Conclusions Early diagnosis and multidisciplinary collaborations are keys to the successful management of this patient. Flexible bronchoscopy is particularly useful in airway management for urgent trachea tracheal laceration repair.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anesthetic management of tracheal laceration from traumatic dislocation of the first rib: a case report and literature of the review

et al. 2019

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“…Symptoms of tracheal injury may be easily overlooked in patients with other serious injuries. As it is difficult to make an early diagnosis, treatment may be delayed, eventually leading to tracheal stenosis or atresia, which may be life-threatening [2]. The rate of early misdiagnosis is reported to be 35–68% [3].…”

Section: Discussionmentioning

confidence: 99%

Clinical features and management of closed injury of the cervical trachea due to blunt trauma

Shen

Zhang

et al. 2013

Scand J Trauma Resusc Emerg Med

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BackgroundWe retrospectively reviewed the presentation, diagnosis, treatment, and outcomes of patients with closed injury of the cervical trachea. We evaluated factors that improve diagnosis and treatment, reduce mortality, and avoid tracheal stenosis.MethodsWe reviewed the clinical data of 17 patients with closed injury of the cervical trachea. All patients underwent CT scanning or endoscopy, tracheal exploration, low tracheotomy, and tracheal repair.ResultsIn 12 patients, breathing, phonation, and swallowing functions had returned to normal at 2 weeks. In three patients, breathing and swallowing functions had recovered at 2 weeks, but hoarseness continued. In two patients, tracheal stenosis prevented extubation and required further surgery; in these patients breathing and swallowing functions had recovered at 6 months.ConclusionsClosed injury of the cervical trachea may cause airway obstruction and is potentially life-threatening. Early diagnosis and repair to restore structure and function are important to ensure survival and avoid tracheal stenosis.

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“…5 19 25 Blood loss and upper airway obstruction are the major determinants of injury severity. 14 38 40 Wounds in the anterior and lateral aspects of the neck compromise the airway more often than those in the posterior region. 11 20 25 40 42 The clinician should also consider the presence of blood and debris within the lumen of the airway, injury within the airway wall itself, or injury outside the wall (e.g.…”

Section: Penetrating and Blast Injurymentioning

confidence: 99%

Systematic review of the anaesthetic management of non-iatrogenic acute adult airway trauma

Mercer

Jones

Bridge

et al. 2016

British Journal of Anaesthesia

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The hallmark of airway management with trauma to the airway is the maintenance of spontaneous ventilation, intubation under direct vision to avoid the creation of a false passage, and the avoidance of both intermittent positive pressure ventilation and cricoid pressure (the latter for laryngotracheal trauma only) during a rapid sequence induction. Management depends on available resources and time to perform airway assessment, investigations, and intervention (patients will be classified into one of three categories: no time, some time, or adequate time). Human factors, particularly the development of a shared mental model amongst the trauma team, are vital to mitigate risk and improve patient safety.

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Survival after traumatic complete laryngotracheal transection

Cited by 12 publications

References 4 publications

Anesthetic management of tracheal laceration from traumatic dislocation of the first rib: a case report and literature of the review

Anesthetic management of tracheal laceration from traumatic dislocation of the first rib: a case report and literature of the review

Clinical features and management of closed injury of the cervical trachea due to blunt trauma

Systematic review of the anaesthetic management of non-iatrogenic acute adult airway trauma

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