Tracheobronchial injuries: tertiary center experience

Saleh, Mohamed Elshabrawy; Beshir, Hatem; Mohammed, Walid Hassan; Sanad, Mohammed

doi:10.1177/0218492319893822

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…Therefore, differential diagnosis is required when posttraumatic atelectasis exists. The most important diagnostic methods are 3D-spiral CT and FB, especially FB, which is recognized as the gold standard for diagnosis[ 14 , 15 , 17 - 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Management and outcome of bronchial trauma due to blunt versus penetrating injuries

Jin-mou¹,

Li²,

Du³

et al. 2022

WJCC

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BACKGROUND The number of patients with bronchial trauma (BT) who survived to hospital admission has increased with the improvement of prehospital care; early diagnosis and treatment should be considered, especially among blunt trauma patients, whose diagnosis is frequently delayed. AIM To describe the early recognition and surgical management considerations of blunt and penetrating BTs, and to elaborate the differences between them. METHODS All patients with BTs during the past 15 years were reviewed, and data were retrospectively analyzed regarding the mechanism of injury, diagnostic and therapeutic procedures, and outcomes. According to the injury mechanisms, the patients were divided into two groups: Blunt BT (BBT) group and penetrating BT (PBT) group. The injury severity, treatment procedures, and prognoses of the two groups were compared. RESULTS A total of 73 patients with BT were admitted during the study period. The proportion of BTs among the entire cohort with chest trauma was 2.4% (73/3018), and all 73 underwent thoracotomy. Polytrauma patients accounted for 81.6% in the BBT group and 22.9% in the PBT group, and the mean Injury Severity Score was 38.22 ± 8.13 and 21.33 ± 6.12, respectively. Preoperative three-dimensional spiral computed tomography (CT) and/or fiberoptic bronchoscopy (FB) were performed in 92.1% of cases in the BBT group ( n = 38) and 34.3% in the PBT group ( n = 35). In the BBT group, a delay in diagnosis for over 48 h occurred in 55.3% of patients. In the PBT group, 31 patients underwent emergency thoracotomy due to massive hemothorax, and BT was confirmed during the operation. Among them, 22 underwent pulmo-tractotomy for hemostasis, avoiding partial pneumonectomy. In this series, the overall mortality rate was 6.9% (5/73), and it was 7.9% (3/38) and 5.7% (2/35) in the BBT group and PBT group, respectively ( P > 0.05). All 68 survivors were followed for 6 to 42 (23 ± 6.4) mo, and CT, FB, and pulmonary function examinations were performed as planned. All patients exhibited normal lung function and healthy conditions except three who required reoperations. CONCLUSION The difference between blunt and penetrating BTs is obvious. In BBT, patients generally have no vessel injury, and the diagnosis is easily missed, leading to delayed treatment. The main cause of death is ventilation disturbance due to tension pneumothorax early and refractory atelectasis with pneumonia late. However, in PBT, most patients require emergency thoracotomy because of simultaneous vessel trauma and massive hemothorax, and delays in diagnosis are infrequent. The leading cause of death is hemorrhagic shock.

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Section: Discussionmentioning

confidence: 99%

“…One patient in this group suffered such an outcome (Table 1 ). Debridement should be performed before anastomosis; otherwise, the rate of failure or complications, such as leakage and stenosis due to granulation, will increase[ 2 , 3 , 14 , 17 ]. If the lung can be expanded, anastomosis can be performed.…”

Section: Discussionmentioning

confidence: 99%

Management and outcome of bronchial trauma due to blunt versus penetrating injuries

Jin-mou¹,

Li²,

Du³

et al. 2022

WJCC

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“…We however performed flexible bronchoscopy in 4 patients after chest trauma to assess the airway before thoracotomy. This indication is hardly referred to in published literature but is a common one used by thoracic surgeons to assess airway injury or pathology related to the trauma [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Flexible bronchoscopy in Ghana: initial experience in a tertiary hospital

Issaka¹,

Adjeso²,

Yabasin³

2021

Pan Afr Med J

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Introduction the use of flexible bronchoscopy in developing countries is limited. We report our initial experience and outcome with the use of flexible bronchoscopy at the Tamale Teaching Hospital in Ghana. This is the first reported case series of flexible bronchoscopy in Ghana. Methods a retrospective review of patients who had flexible bronchoscopy from 2017-2019 was analyzed. Patient demographics and outcomes were summarized using frequency distribution and percentages. Results we performed flexible bronchoscopies in 33 patients with mean age of 43 years. All patients were symptomatic at the time of presentation with the most common symptoms being chest pain (63.6%), dyspnea (57.6%) and cough (48.5%). The indication for bronchoscopy in most of the cases were suspected malignancy in 16 (48.5%) followed by infection 9 (27.3%), trauma 4 (12.1%) and others 4 (12.1%). We observed abnormal bronchoscopic findings in 25 (75.8%) of the cases with most of the pathologies in the right main bronchus. Twelve patients had toilet bronchoscopy, 6 had biopsy, 5 had no intervention and 4 patients had bronchoalveolar lavage (BAL). Culture and sensitivity results were available for 11 patients, of which 7 patients had negative results. Thirteen (13) malignancies and 11 inflammatory/infectious diseases were diagnosed in this case series. The mean procedure time was 32 minutes with mean hospital stay of 7 days. There was no complication or mortality in our series. Conclusion: flexible bronchoscopy is a safe procedure and indispensable in Ghana where there is an increasing incidence of lung diseases.

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“…The distal bronchial tree remains sterile and continues to secrete mucus, and the air is rapidly absorbed. The lungs become atelectatic but without infection, abscess, or bronchiectasis [5].…”

Section: Review Of Literaturementioning

confidence: 99%

Right Main Bronchus Disruption Discovered after One Year of Blunt Chest Trauma

Moustafa¹

2022

OJTS

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Central airway injury is a very rare entity during blunt chest trauma. It is serious and may be fatal. Usually, it has fundamental manifestations but in some cases, it is insidious and has been discovered lately. It's suspected when major air leaks from the chest tube and the lung fail to expand despite adequate chest drainage. Right main bronchus injuries are the most frequent. Diagnosis can be suspected clinically and confirmed by Ct scan and bronchoscopy. Conservative management can be applied in special cases but the majority of cases need surgical intervention which depends on primary reconstruction. An early diagnosis and treatment can avoid dramatic complications and provide complete recovery. Associated other organ injury is common and is an important mortality factor. Close cooperation with the emergency team and anesthesiologists is necessary. Here I presented a case of right main bronchus disruption discovered after one year of blunt chest trauma with complete lung atelectasis, managed successfully by resection of the fibrotic injured bronchus and primary reconstruction saving the lung.

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Tracheobronchial injuries: tertiary center experience

Cited by 5 publications

References 17 publications

Management and outcome of bronchial trauma due to blunt versus penetrating injuries

Management and outcome of bronchial trauma due to blunt versus penetrating injuries

Flexible bronchoscopy in Ghana: initial experience in a tertiary hospital

Right Main Bronchus Disruption Discovered after One Year of Blunt Chest Trauma

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