Thoracic Anesthesia and Cross Field Ventilation for Tracheobronchial Injuries: A Challenge for Anesthesiologists

Abstract

Tracheobronchial injuries are rare but life threatening sequel of blunt chest trauma. Due to the difficult nature of these injuries and the demanding attributes of the involved surgery, the anesthesiologist faces tough challenges while securing the airway, controlling oxygenation, undertaking one-lung ventilation, maintaining anesthesia during tracheal reconstruction, and gaining adequate postoperative pain control. Amongst the few techniques that can be used with tracheobronchial injuries, cross field ventilation is a remotely described and rarely used technique, especially in injuries around the carina. We effectively applied cross field ventilation in both our cases and the outcome was excellent.

Tracheal stenosis and reconstructive surgery: Our experience on anesthesia and airway management

“…[10] Gas exchange failure (hypercapnia and hypoxia) during HFJV is common as reported previously and can limit its use despite the transient character of these complications. [11] Although hypercapnia was stated as the most frequent complication of the method, we did not observe any problem regarding CO 2 retention during HFJV. We were obligated to discontinue HFJV and switch to other ventilation modalities in our two patients because of hypoxia.…”

Use of Univent tube for intermittent lung isolation during thoracoscopic mediastinal tracheal resection and reconstruction

“…[ 7 ] Cross-field ventilation has also been described in the surgical literatures as being used in complex tracheal surgeries. [ 8 ] The cross-field endobronchial tube, which may hinder surgeons’ view, may lead the procedure more difficult during VATS tracheoplasty.…”

Anesthetic Management of a Delayed Carinal Resection Following Traumatic Disruption

“…Tracheobronchial disruptions are involved in 0.5% -2% of all severe blunt trauma, and 59% of these injuries are the result of an MVA [6]. Up to 80% of patients with tracheobronchial injuries die within the first 2 hours, though the rate of patients surviving to the hospital is increasing due to improved prehospital care [6]- [8]. The most common initial signs of tracheobronchial disruption are dyspnea and subcutaneous emphysema, with pneumomediastinum and pneumothorax being seen on imaging [7].…”

“…Currently, cross-field ventilation is the most common practice for carinal resections [15]. This approach has been used successfully in the acute setting with traumatic disruptions, before the onset of secondary injury such as ARDS [8]. With this approach, a sterile circuit is connected through, or distal to, the carinal injury and then passed from the operative field to the anesthesiologist.…”