The use of fibrin glue for the endoscopic management of post-intubation tracheal lacerations: a case series

Abstract

Background: Post-intubation tracheal laceration (PITL) is a rare but serious complication of orotracheal intubation. The management is still debated and depends on the characteristics of the lesion and the conditions of the patients. Herein, we reported a consecutive series of patients with PITLs undergoing endoscopic application of fibrin glue to define the success of the procedure.Case Description: Our study population included 16 consecutive patients with PITL; of these, 14 were treated with endoscopic application of fibrin glue, 1 underwent upfront surgical repair and 1 underwent surgical repair after a failed attempt at endoscopic treatment. In both patients undergoing surgical repair, the tracheal lesion involved the carina and right main bronchus, with evidence of esophageal bulging.Endoscopic treatment consisted in the bronchoscopic application of fibrin glue with a specific endoscopic catheter. The mean post-operative length of hospital stay was of 10.5 (±4) days. All the tracheal lesions were completely healed at endoscopic follow-up 3 months after discharge. The 30-day mortality rate was 0 and there were no major complications, including pneumonia and mediastinitis. Conclusions:The endoscopic application of fibrin glue for management of PITL is safe and could be considered in selected cases as a treatment, though direct evidence of its effectiveness is still limited.