Surgical approaches to membranous tracheal wall lacerations

Mussi, Alfredo; Ambrogi, Marcello Carlo; Menconi, G; Ricci, Alessandro; Angeletti, Carlo Alberto

doi:10.1067/mtc.2000.107122

Cited by 71 publications

(45 citation statements)

References 14 publications

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“…In the series of patients reported by Hofmann et al, pneumothorax was observed in one out of 19 cases [1]. In other reported series, the incidence of pneumothorax varied widely, from 0% to 60% [14,15].…”

Section: Discussionmentioning

confidence: 82%

“…Therefore, the likelihood of tracheal injury occurring during intubation is smaller but malposition of the tube is more frequent. Other serious complications such as ventillation problems and hypoxaemia are equally common with both types of tubes [14,15]. At the University Medical Centre Ljubljana, Robertshaw tubes are not used because of frequent malpositioning.…”

Section: Discussionmentioning

confidence: 99%

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Iatrogenic rupture of the trachea caused by double Lumen tube intubation

2010

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AbstractAcute injuries of the tracheobronchial system are rare and life-threatening situations. Tracheal rupture most commonly occurs after blunt trauma to the chest. It is a rare but most concerning immediate complication of intubation. One-lung ventilation is required in lung surgery. Video assisted thoracoscopic procedures are an absolute indication for one-lung intubation. The double-lumen tube is the mainstay of one lung ventilation. Due to their larger size and rigidity, double lumen tubes are more difficult to insert, and complications are more common than with single lumen tubes. Opinions about the need for checking routinely the position of a double lumen tube by fiber optic bronchoscopy directly after intubation are divided. A 69-year-old woman with epidermoid lung carcinoma was scheduled for video assisted thoracoscopic left upper pulmonary lobectomy under general anaesthesia. The patient was prepared for the operation and itubated with the Carlens double lumen tube as usual. On introducing the camera into the thoracic cavity, the surgeon noted that the lungs were not completely collapsed. During blind adjustment the position of the tube the trachea was ruptured. The right-sided thoracotomy was performed and closed the greater part of the tracheal laceration. Only its upper 1.5-cm segment was surgically inaccessible because of the anatomical situation and thus remained unsutured. The patient received antibiotics, continuous airway humidification, analgesia with piritramide, and chest physiotherapy. She had no complications. In the literature, opinions about checking routinely the position of a double lumen tube by fiber optic bronchoscopy are divided.. Possibly, the very serious complication encountered in our patient could have been avoided, had the tube position been checked by bronchoscopy. The treatment strategy for post-intubation tracheal rupture depends on the size and location of the rupture, its clinical presentation, and the overall condition of the patient). Early surgical repair is the treatment of choice for most patients when a transmural tear with a length exceeding 2 cm. In our the combination of surgical and conservative treatment was performed. The uppermost part of the tear could not be sutured because of the anatomical situation, and so about 1.5 cm of the trachea remained open. The case is interesting from many perspectives. It shows that intubation with a Carlens tube is a potentially hazardous procedure, which should be performed only by experienced anaesthesiologists. Furthermore, our case report underscores the importance of checking routinely the position of a double lumen tube by fiber optic bronchoscopy. It provides evidence that minor tracheal lacerations can be successfully managed by conservative measures.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Iatrogenic rupture of the trachea caused by double Lumen tube intubation

2010

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“…4,9,12,14) In an emergency situation, the first step is the establishment of a secure airway. If the injured airway is exposed, the best and simplest way is direct intubation of the airway via the wound 15,16) as two cases of ours. Otherwise, if the patient has spontaneous respiration and seems to have enough time to reach the hospital alive, it is better not to intubate the patient, because oral intubation may kill an alive dyspneic patient by converting a partial airway obstruction to a complete obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Contrast studies, esophagoscopy or intraoperative exploration may be performed to rule out any esophageal tearing. 16) If an esophageal injury is missed, or inappropriately repaired, esophageal leakage, mediastinitis, disruption of repaired airway and tracheoesophageal fistula may happen. 4,18) If the hypopharynx or esophagus is injured, it should be meticulously debrided and repaired in two layers.…”

Section: Discussionmentioning

confidence: 99%

“…If the airway trauma is minor, the airway continuity is provided, and the patient is stable and has no pneumothorax, our choice is conservative treatment, 6,10,11,16,17,[19][20][21] which is referred to do no surgical repair and keep the patient hospitalized and monitor his or her respiratory status. This was the case in three of our iatrogenic patients, all with good results.…”

Section: Discussionmentioning

confidence: 99%

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Major Airways Trauma, Management and Long Term Results

Farzanegan

Alijanipour

Akbarshahi

et al. 2011

ATCS

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Purpose: The number of patients with traumatic and iatrogenic tracheobronchial injuries is increasing. Early diagnosis, prompt establishment of a secure airway, and appropriate management could prevent sequelae and lead to a good outcome. Methods: Between "1994-2007", 35 patients with major airways trauma were managed. This descriptive and retrospective study evaluates clinical findings, diagnostic approaches, initial managements, definitive surgical or nonsurgical treatments and follow-up results. SPSS was used for descriptive outcomes. Results: There were 27 males (77%) and 8 females, with a mean age of 28.2. There were 16 blunt, 11 penetrating and 8 iatrogenic traumas, at the level of the larynx in 1, larynx and hypopharynx in 3, laryngotracheal in 12, tracheal in 13, tracheobronchial in 1, and main bronchi in 5 patients. Fourteen patients (40%) were initially managed, and 21 patients were referred to us after their initial managements at outside hospitals. There were 7 complications (20%); one resulted in mortality (2.9%). The overall final results were good in 57.1%, acceptable in 31.4% and poor in 5.7% of patients, (mean follow-up time, 58.2 months). The respiratory status and the phonation looked better in the initially managed than the delayed managed group. Conclusion: We recommend that, patients only become respiratory stable with minimum intervention and then be referred to centers with sufficient experience in airway surgery.

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Tracheal Resection and Reconstruction

McRae

2011

Principles and Practice of Anesthesia for Thoracic Surgery

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Surgical approaches to membranous tracheal wall lacerations

Cited by 71 publications

References 14 publications

Iatrogenic rupture of the trachea caused by double Lumen tube intubation

Iatrogenic rupture of the trachea caused by double Lumen tube intubation

Major Airways Trauma, Management and Long Term Results

Tracheal Resection and Reconstruction

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