Treatment of Tracheobronchial Injuries

Abstract

Tracheobronchial injury is a rare but a potentially high-impact event with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma and iatrogenic injury that might occur during surgery, endotracheal intubation, or bronchoscopy. Early recognition of clinical signs and symptoms can help risk-stratify patients and guide management. In recent years, there has been a paradigm shift in the management of tracheal injury towards minimally invasive modalities, such as endobronchial stent placement. Although there are still some definitive indications for surgery, selected patients who meet traditional surgical criteria as well as those patients who were deemed to be poor surgical candidates can now be managed successfully using minimally invasive techniques. This paradigm shift from surgical to nonsurgical management is promising and should be considered prior to making final management decisions.

Competence in pulmonary endoscopy emergencies

“…74 cardillo et al proposed a morphologic classification of iTi (Table iv). 75 iTi presenting with acute respiratory distress requires immediate action to promptly and effectively re-establish and secure a patient airway and relieve the injury. This is often achieved with rigid bronchoscope.…”

“…The stent can be removed after 4 to 6 weeks as the healing of the tear is noted. 75 Procedural steps 1) clinical suspicion (acute respiratory distress after extubation; pneumothorax, pneumomediastinum) 2) cT chest imaging (with oral contrast in case of concomitant esophageal injury) 3) Bronchoscopy (diagnosis and treatment)…”

Prognostic Factors for Iatrogenic Tracheal Rupture: A Single-Center Retrospective Cohort Study

“…Tracheal intubations are the most common causes of iatrogenic tracheal ruptures, and patient-related risk factors may be short body height, female sex, old age, chronic obstructive pulmonary disease, and steroid use, which may be related to increased vulnerability of respiratory system tissue [2,[5][6][7]. Operator-related factors may be a lack of procedural experience, emergency conditions, inappropriate use of stylets and large tube sizes, and cuff over-inflations [1][2][3]. Collectively, we found only moderate agreement (apart from emergency versus elective intubation) with these rather unspecific risk factors in our study.…”

“…Iatrogenic tracheal ruptures are rare but severe complications of medical interventions. Their incidence is reported to be approximately 0.005% in single-lumen intubations, 0.05-0.19% in double-lumen intubations, and up to 1% in percutaneous dilation tracheotomies [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The risk factors are unspecific and not applicable for identifying high-risk patients, given the high numbers of procedures that are performed daily.…”

“…Due to different causative events, which are each associated with various risk factors (i.e., skills and training of the operator, anatomy and morbidity of the patient), clear prognostic determinants are difficult to identify. There is a common agreement that prognosis is widely dependent on the severity of underlying diseases, but studies focusing on outcome prediction are scarce [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. In the literature, predictive power related to outcomes has been observed for delayed diagnosis and therapy in general, surgical or conservative treatment in particular, and occurrence of mediastinitis, sepsis, and suture insufficiency [1][2][3][4][5][6][7][8][9][10][11][12][13][14].…”