Anaesthetic management of tracheobronchial rupture following blunt chest trauma

Abstract

Injuries to the tracheobronchial tree are a well-recognized sequel of massive blunt trauma to the chest, and although unusual, are life threatening. We report a 16-year-old-boy who developed complete disruption of both bronchi after a motor vehicle accident. After induction of general anaesthesia and oral intubation, ventilation could not be maintained, and oxygenation worsened abruptly with peripheral oxygen saturation values less than 60%. Jet ventilation through two intrabronchial catheters, inserted via emergency thoracotomy, raised the saturation from 60% to 100%, and surgery thereafter was straightforward. The anaesthetic management of tracheobronchial repair is discussed.

Successful anesthetic management in a child after traumatic rupture of left main bronchus by a single-lumen cuffed-endotracheal tube

“…This type of ventilation was used during both intra-and post-operative settings to avoid high-positive airway pressures and the need for a cuffed-ET, which could damage the tracheal suture line. [2] The proper assessment of the patient regarding both clinical and investigational points is a key point in our case. CT demonstrated the severity of the injury, hence cardiac surgical team was alerted, and full preparation of CPB was made as a backup during the removal of the TT.…”

“…[4] This has been attributed to the fact that the left main bronchus is relatively protected by the aorta. Anatomically, the been published, [1,2,8] but little information is available about their anesthetic management.…”

“…[1,2] It may result from a complicating emergent endotracheal intubation, [1] following the use of endotracheal tube (ET) introducers or as a result of blunt chest trauma. [2] Incidence of tracheobronchial injuries (TBI) due to road traffic accidents constitutes 59% of the cases. Because of the hard bone contour in adults as compared with pliable chest wall in children, these injuries are 10 times more common in adults than in children.…”

“…[5] Most patients of TBI present with cervical subcutaneous emphysema, pneumothorax, cyanosis, pneumomediastinum, and respiratory insufficiency. [2] A continuing pneumothorax despite chest drainage on initiation of positive pressure ventilation should alert the physician to the underlying airway injury [6] or massive lung parenchymal injury. There are few reports of airway management by single-lumen ET in young pediatric patients because of the nonavailability of pediatric size double-lumen tube (DLT).…”

Complete disruption of right main bronchus

“…Finally, there are alternate management options for the management of complete tracheobronchial disruption that include jet ventilation through intrabronchial catheters [11], emergency cardiopulmonary bypass or emergency thoracotomy with direct intubation of the main-stem bronchus [8].…”