Blunt tracheobronchial injuries: treatment and outcomes

Isolated Complete Rupture of Left Main Bronchus after Blunt Chest Trauma

“…In the case of a complete rupture the bronchoscope should be used as a guide during intubation either with a double lumen tube or with a single tube [4,7,13,15]. The authors did not find any need to use either ECMO or transthoracic bronchial intubation, as mentioned in other reports [11,16].…”

“…Complex lesions are very rarely seen, comprising 8% of all ruptures [1]. Left mainstem bronchial ruptures are very rare if one considers that in the 28-year experience of Rossbach et al [8] only one such rupture is present and in the review by Kiser et al [4] were only 21 left-sided bronchial ruptures compared to 61 right ones.…”

“…The true incidence of tracheobronchial injury is hard to establish, as a long proportion (30 to 80%) will die before reaching the hospital [3]. Left-sided injuries occur less frequently compared to right-sided ones, probably due to the length of left mainstem bronchus [4][5][6][7][8][9][10][11][12][13] (Table 1).…”

“…There are several theories regarding the mechanism of blunt tracheobronchial disruption [1,3,4,8,14]. The first hypothesis states that a direct impact to the chest decreases the antero posterior diameter of the thorax while increasing the transverse one.…”

“…Bronchoscopy is the main diagnostic procedure to confirm a bronchial disruption and should be performed in all patients with severe thoracic trauma [1,4,7,8,10,13,15]. In the case of a complete rupture the bronchoscope should be used as a guide during intubation either with a double lumen tube or with a single tube [4,7,13,15].…”