Management of Tracheobronchial Disruption Secondary to Nonpenetrating Trauma

Kirsh, Marvin M.; Orringer, Mark B.; Behrendt, Douglas M.; Sloan, Herbert

doi:10.1016/s0003-4975(10)63961-6

Cited by 239 publications

(108 citation statements)

References 25 publications

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“…Therefore, some authors recommend repeating the bronchoscopy in the face of clinical suspicion. In intubated patients, where possible, the tube should be removed for proper evaluation 4,6,11,15 . Regarding bronchography, it is believed to have value for chronic lesions, but it is not a recommended test for the diagnosis of injuries soon after trauma, being even contraindicated in this phase by some authors 9 .…”

Section: Discussionmentioning

confidence: 99%

Tracheobronchial injuries in chest trauma: a 17-year experience

Saad¹,

Gonçalves²,

Dorgan³

et al. 2017

Rev. Col. Bras. Cir.

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Objective: to discuss the clinical and therapeutic aspects of tracheobronchial lesions in victims of thoracic trauma. Methods: we analyzed the medical records of patients with tracheobronchial lesions treated at the São Paulo Holy Home from April 1991 to June 2008. We established patients' severity through physiological (RTS) and anatomical trauma indices (ISS, PTTI). We used TRISS (Trauma Revised Injury Severity Score) to evaluate the probability of survival. Results: nine patients had tracheobronchial lesions, all males, aged between 17 and 38 years. The mean values of the trauma indices were: RTS - 6.8; ISS - 38; PTTI - 20.0; and TRISS - 0.78. Regarding the clinical picture, six patients displayed only emphysema of the thoracic wall or the mediastinum and three presented with hemodynamic or respiratory instability. The time interval from patient admission to diagnosis ranged from one hour to three days. Cervicotomy was performed in two patients and thoracotomy, in seven (77.7%), being bilateral in one case. Length of hospitalization ranged from nine to 60 days, mean of 21. Complications appeared in four patients (44%) and mortality was nil. Conclusion: tracheobronchial tree trauma is rare, it can evolve with few symptoms, which makes immediate diagnosis difficult, and presents a high rate of complications, although with low mortality.

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Section: Discussionmentioning

confidence: 99%

Tracheobronchial injuries in chest trauma: a 17-year experience

Saad¹,

Gonçalves²,

Dorgan³

et al. 2017

Rev. Col. Bras. Cir.

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“…Although subcutaneous emphysema and pneumomediastinum are self-limiting conditions with rapid recovery with conservative treatment, life-threatening complications may develop. The usual symptoms that herald this complication are subcutaneous and mediastinal emphysema, hemoptysis and in severe cases dyspnea and cyanosis [14]. Spontaneously occurring SE presents with clinically impressive and dramatic features [15].…”

Section: Discussionmentioning

confidence: 99%

“…More than 80 % of the injuries to the trachea are within 2.5 cm of the carina [14]. Bronchoscopy is necessary to confirm the exact location and extent of the tracheal injury.…”

Section: Discussionmentioning

confidence: 99%

Early Postoperative Malignant Subcutaneous Emphysema: Report and Review

Sahoo¹,

Singh²,

Roy³

et al. 2016

J. Maxillofac. Oral Surg.

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Background Subcutaneous emphysema is defined as presence of air or gas in subcutaneous tissue layer. It may be localized or generalized due to various aetiological factors. Although SE and pneumomediastinum are selflimiting conditions, life-threatening complications may develop. Escape of air into both pleural cavity causing bilateral pneumothorax and tension pneumothorax can be termed as malignant emphysema. Purpose To report a case of malignant generalized subcutaneous emphysema in early postoperative phase following palatoplasty. Case Report A 25 year old female patient was operated for closure of residual oronasal communication using an anteriorly based tongue flap. The patient was reversed from general anesthesia and shifted to the post-operative room with the endotracheal tube in situ. Sudden swelling of the face and periorbital area was noticed which spread all over the body. A diagnosis of malignant post-operative subcutaneous emphysema was made and the patient was shifted back to the operation theatre. She was managed successfully by bilateral tube thoracotomy and tracheostomy.Conclusion Close observation of the patient in early postoperative stage having endotracheal tube in situ is crucial to avoid such complication. Regardless of aetiology, early recognition of the clinical features of tension pneumothorax and timely intervention are necessary for the survival of the patient.

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“…Em 1959, Hood e Sloan (7) relataram melhora importante nos resultados após reparação cirúrgica imediata dessas lesões. Desde então, várias séries demonstraram que o diagnóstico precoce e o tratamento cirúrgico dessas lesões diminuem as complicações e melhoram os resultados a longo prazo (8,9) . Pacientes que possuem solução de continuidade da pleura mediastinal apresentam-se com dispnéia; evidência de pneumotórax, ocasionalmente hipertensivo; enfisema mediastinal e subcutâneo; e mínima hemoptise.…”

Section: Discussionunclassified

Ruptura traqueobrônquica por trauma torácico fechado: avaliação e manuseio

Junior¹,

Coelho²,

Zampier³

et al. 1999

J. Pneumologia

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tratou cirurgicamente dois casos de ruptura completa do brônquio principal esquerdo e um caso de ruptura traqueobrônquica por trauma torácico fechado, durante um período de dois anos. A técnica utilizada para reconstrução brônquica foi através de anastomose término-terminal com pontos separados utilizando-se fios absorvíveis, após ressecção das margens estenosadas ou desbridamento das margens afetadas. Todos os pacientes obtiveram boa evolução; o tempo médio para retirada dos drenos torácicos foi de 3,6 dias e o tempo médio para alta do Serviço de Cirurgia Torácica foi de 5,6 dias. O seguimento dos pacientes foi feito através de radiografia simples de tórax em duas incidências (PA e perfil), provas de função pulmonar e broncofibroscopia. (J Pneumol J Pneumol J Pneumol J Pneumol J Pneumol 1999;25(2):118-123) Tracheobronchial rupture by blunt chest trauma: evaluation and management INTRODUÇÃOEmbora haja melhora no reconhecimento, lesões brônqui-cas continuam raras em vítimas de grandes traumas (1) . A incidência de trauma não penetrante vem crescendo significativamente neste século devido ao aumento da velocidade dos meios de transporte (2) . Nos últimos anos, progressos foram feitos no reconhecimento e tratamento de lesões de vias aé-reas (1) .A grande maioria das lesões traqueobrônquicas ocorre como resultado de colisões automobilísticas. A pessoa que mais freqüentemente está envolvida é o motorista, embora os outros passageiros também possam sofrer tais lesões, incluindo as crianças (3) . Os mecanismos de lesão da árvore traqueobrônquica no trauma torácico fechado podem ser: 1) aumento abrupto na pressão intratraqueal e/ou intrabrôn-quica com a glote fechada, levando a laceração longitudinal na parede membranosa da traquéia; 2) desaceleração brusca, produzindo forças de cisalhamento, fazendo com que Siglas e abreviaturas utilizadas neste trabalho CV -Capacidade vital VEF 1 -Volume expiratório forçado no primeiro segundo PA -Póstero-anterior TAC -Tomografia axial computadorizada PO -Pós-operatório LC2 -Carina entre o brônquio segmentar da língula do lobo superior esquerdo e o brônquio lobar inferior esquerdo SO 2 -Saturação de oxigênio bpm -Batimentos por minuto ipm -Incursões por minuto Descritores -Ruptura traqueobrônquica. Trauma torácico fechado. Avaliação. Tratamento.

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Management of Tracheobronchial Disruption Secondary to Nonpenetrating Trauma

Cited by 239 publications

References 25 publications

Tracheobronchial injuries in chest trauma: a 17-year experience

Tracheobronchial injuries in chest trauma: a 17-year experience

Early Postoperative Malignant Subcutaneous Emphysema: Report and Review

Ruptura traqueobrônquica por trauma torácico fechado: avaliação e manuseio

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