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Boukhidous L, Kharouaa B, Zarouki S, Marouf R, Thouil A, Kouismi H. A Young Woman Presenting With a Post-traumatic Tracheal Wound. Cureus 2023; 15:e39452. [PMID: 37362471 PMCID: PMC10289881 DOI: 10.7759/cureus.39452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Tracheobronchial injury is a rare but potentially fatal occurrence, with most cases resulting from penetrating trauma or blunt and iatrogenic injury during medical procedures such as endotracheal intubation, bronchoscopy, or surgery. Early recognition of clinical symptoms can help stratify patient risk and guide management, though these symptoms are often non-specific. We report the case of a 42-year-old patient who presented with post-traumatic chest pain from a sharp object. Radiographic investigation revealed pneumomediastinum and significant subcutaneous emphysema, while bronchial fibroscopy confirmed a wound on the posterior surface of the trachea. The patient underwent surgery with an uneventful postoperative course. Follow-up radiographic evaluation three weeks later showed healing of the tracheal wound and good clinical improvement.
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Affiliation(s)
- Latifa Boukhidous
- Department of Respiratory Diseases, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, MAR
| | - Badr Kharouaa
- Department of Respiratory Diseases, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, MAR
| | - Sara Zarouki
- Department of Thoracic and Cardio-Vascular Surgery, Faculty of Medicine and Pharmacy of Oujda, Mohammed VI University Hospital, Mohammed First University, Oujda, MAR
| | - Rachid Marouf
- Department of Thoracic and Cardio-Vascular Surgery, Faculty of Medicine and Pharmacy of Oujda, Mohammed VI University Hospital, Mohammed First University, Oujda, MAR
| | - Afaf Thouil
- Department of Respiratory Diseases, Mohammed VI University Hospital, Oujda, MAR
- Laboratory of Research and Medical Sciences (LRSM), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Hatim Kouismi
- Department of Respiratory Diseases, Mohammed VI University Hospital, Oujda, MAR
- Laboratory of Research and Medical Sciences (LRSM), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
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2
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Yuan Y, Lin X, Suo Z, Zhang H, Wu J. Anticoagulation-free Extracorporeal Membrane Oxygenation in Severe Bronchial and Lung Trauma. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00105-2. [PMID: 36948911 DOI: 10.1053/j.jvca.2023.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 02/21/2023]
Affiliation(s)
- Yunsheng Yuan
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital/Shenzhen Nanshan People's Hospital, Shenzhen, China
| | - Xiaohua Lin
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital/Shenzhen Nanshan People's Hospital, Shenzhen, China
| | - Zhijun Suo
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital/Shenzhen Nanshan People's Hospital, Shenzhen, China
| | - Haigang Zhang
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital/Shenzhen Nanshan People's Hospital, Shenzhen, China
| | - Jinglan Wu
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital/Shenzhen Nanshan People's Hospital, Shenzhen, China.
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3
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Iyengar KP, Venkatesan AS, Jain VK, Shashidhara MK, Elbana H, Botchu R. Risks in the Management of Polytrauma Patients: Clinical Insights. Orthop Res Rev 2023; 15:27-38. [PMID: 36974036 PMCID: PMC10039633 DOI: 10.2147/orr.s340532] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Polytrauma, a patient's condition with multiple injuries that involve multiple organs or systems, is the leading cause of mortality in young adults. Trauma-related injuries are a major public health concern due to their associated morbidity, high disability, associated death, and socioeconomic consequences. Management of polytrauma patients has evolved over the last few decades due to the development of trauma systems, improved pre-hospital assessment, transport and in-hospital care supported by complementary investigations. Recognising the mortality patterns in trauma has led to significant changes in the approach to managing these patients. A structured approach with application of advanced trauma life support (ATLS) algorithms and optimisation of care based on clinical and physiological parameters has led to the development of early appropriate care (EAC) guidelines to treat these patients, with subsequent improved outcomes in such patients. The journey of a polytrauma patient through the stages of pre-hospital care, emergency resuscitation, in-hospital stabilization and rehabilitation pathway can be associated with risks at any of these phases. We describe the various risks that can be anticipated during the management of polytrauma patients at different stages and provide clinical insights into early recognition and effective treatment of these to improve clinical outcomes.
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Affiliation(s)
- Karthikeyan P Iyengar
- Department of Orthopaedics, Southport and Ormskirk NHS Trust, Southport, UK
- Correspondence: Karthikeyan P Iyengar, Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, UK, PR8 6PN, Tel +44-1704-704926, Email
| | | | - Vijay K Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Husam Elbana
- Department of Orthopaedics, Royal Lancaster Infirmary, Lancaster, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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4
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Aljehani Y, Aldossary I, AlQatari AA, Alreshaid F, Alsadery HA. Blunt Traumatic Tracheobronchial Injury: a Clinical Pathway. Med Arch 2022; 76:430-437. [PMID: 36937611 PMCID: PMC10019869 DOI: 10.5455/medarh.2022.76.430-437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background Motor vehicle collisions (MVC) are a major burden on healthcare systems. Saudi Arabia is one of the countries with a high mortality rate of MVC. Blunt tracheobronchial injuries are rare; however, it is a catastrophic event that requires a high center of care. Lack of experience and advanced faculty prompt early stabilization and transfer of the victim for advanced care. Due to the uncertainty of management of these injuries, we would like to share our experience in dealing with such injuries. Objective To address the difficulties in initial management and transfer of patient with blunt traumatic tracheobronchial injuries. Methods This is a single-center retrospective case-series study including patients admitted as cases of trauma including all age groups with blunt acute tracheobronchial injuries confirmed by imaging or bronchoscope. Results In our study, four patients with tracheobronchial injuries were identified, and a retrospective analysis was performed. Two of the males and one of the females are adults, while the other two are pediatrics. Two of them have a right main bronchial injury and the other two have a left main bronchial injury. Posterolateral thoracotomy and bronchial anastomosis were performed on all four patients and were followed up. Conclusion In Saudi Arabia, blunt trauma is a prevalent type of injury, although tracheobronchial injuries are uncommon. In the event of trauma, a high index of suspicion of tracheobronchial injuries in a high mechanism injury warrants prompt treatment. Due to a lack of experienced and specialized hands in this field, management may be delayed, and eventually lead to unfavorable outcomes, hence we thought of a guide to facilitate the decision-making.
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Affiliation(s)
- Yasser Aljehani
- Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ibrahim Aldossary
- Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Abdulaziz AlQatari
- Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Farouk Alreshaid
- Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Humood Ahmed Alsadery
- Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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5
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Marshall WA, Robles JN, Adams LM, Potenza BM, Kobayashi LM. Robotic repair of traumatic bronchial disruption: A minimally invasive and multi-disciplinary approach to a complex constellation of injuries. Trauma Case Rep 2022; 42:100711. [PMID: 36210921 PMCID: PMC9535302 DOI: 10.1016/j.tcr.2022.100711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
Abstract
Bronchial disruption is a catastrophic consequence of blunt thoracic trauma with high pre-hospital lethality. This injury is classically managed through a large thoracotomy incision to facilitate adequate exposure for open repair. Here, we describe a case of complete bronchus intermedius disruption following a motor vehicle accident that was repaired via robotic thoracoscopy. The patient sustained multi-system trauma, including a grade III liver laceration, an innominate artery pseudoaneurysm, and femoral condyle fracture, all of which required systematic intervention and multi-disciplinary coordination to best facilitate this patient's care. This patient recovered well from his multiple injuries and was discharged after an uneventful post-operative course.
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Affiliation(s)
- W. Aaron Marshall
- University of California San Diego Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, 200 West Arbor Dr., #8896, San Diego, CA 92103-8896, USA,Corresponding author at: University of California San Diego, Department of Surgery, Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, 200 West Arbor Dr., #8896, San Diego, CA 92103-8896, USA.
| | - Julie N. Robles
- University of California San Diego, Department of Anesthesiology, 200 West Arbor Dr., #7770, San Diego, CA 92103-7770, USA
| | - Laura M. Adams
- University of California San Diego Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, 200 West Arbor Dr., #8896, San Diego, CA 92103-8896, USA
| | - Bruce M. Potenza
- University of California San Diego Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, 200 West Arbor Dr., #8896, San Diego, CA 92103-8896, USA
| | - Leslie M. Kobayashi
- University of California San Diego Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, 200 West Arbor Dr., #8896, San Diego, CA 92103-8896, USA
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6
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Aljehani Y, Aldossary I, AlQatari AA, Alreshaid F. WITHDRAWN: Blunt traumatic tracheobronchial injury: A case series and a clinical pathway. Ann Med Surg (Lond) 2022. [DOI: 10.1016/j.amsu.2022.104121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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7
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Kaur A, Singh VP, Gautam PL, Singla MK, Krishna MR. Tracheobronchial Injury: Role of Virtual Bronchoscopy. Indian J Crit Care Med 2022; 26:879-880. [PMID: 36864866 PMCID: PMC9973178 DOI: 10.5005/jp-journals-10071-24271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A tracheobronchial avulsion is a very rare and serious condition that occurs mostly due to blunt trauma chest caused by high-speed traffic accidents. In this article, we present a challenging case of a 20-year-old male who had a right tracheobronchial transection with carinal tear which was repaired on cardiopulmonary bypass (CPB) through right thoracotomy. Challenges faced and a review of literature will be discussed. How to cite this article Kaur A, Singh VP, Gautam PL, Singla MK, Krishna MR. Tracheobronchial Injury: Role of Virtual Bronchoscopy. Indian J Crit Care Med 2022;26(7):879-880.
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Affiliation(s)
- Amandeep Kaur
- Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India,Amandeep Kaur, Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India, Phone: +91 9779656700, e-mail:
| | - Vikram Pal Singh
- Department of CTVS, Dayanand Medical College and Hospital, Punjab, India
| | - Parshotam Lal Gautam
- Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Manender Kumar Singla
- Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - M Ravi Krishna
- Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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8
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Taylor A, Menon S, Grant P, Currie B, Soma M. Traumatic Pediatric Tracheal Rupture After Blunt Force Sporting Injury: Case Report and Review of the Literature. Ann Otol Rhinol Laryngol 2021; 131:923-927. [PMID: 34541893 DOI: 10.1177/00034894211046707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This paper presents the case of a traumatic tracheal rupture in a pediatric patient. The body of literature of the clinical features, evaluation, and management of this uncommon presentation is discussed. CASE A 13-year-old boy sustained an intrathoracic tracheal rupture whilst playing Australian Rules football. He developed hallmark clinical features of air extravasation and was intubated prior to transfer to a tertiary pediatric center for further management. After a short trial of conservative management, his respiratory status deteriorated and he was taken to the operating theater for open surgical repair of the defect. CONCLUSION Traumatic rupture of the trachea is a rare injury in children. This case demonstrates the dynamic nature of this serious injury and the need for multidisciplinary care in achieving the optimal outcome.
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Affiliation(s)
- Alon Taylor
- Department of Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Seema Menon
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Peter Grant
- Department of Cardiothoracic Surgery, Sydney Children's Hospital, Randwick, NSW, Australia.,Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Bruce Currie
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Marlene Soma
- Department of Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
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9
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Pulle MV, Asaf BB, Puri HV, Bangeria S, Bishnoi S, Kumar A. Factors determining surgical outcome after bronchial re-implantation for traumatic main bronchus transection. Lung India 2021; 38:128-133. [PMID: 33687005 PMCID: PMC8098892 DOI: 10.4103/lungindia.lungindia_306_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives: The diagnosis of traumatic transection of main bronchus is often delayed, resulting in attempts at surgical repair sometimes even months after the injury. Our aim is to analyze the factors affecting surgical outcome in patients undergoing lung preserving bronchial re-implantation for bronchial transection. Materials and Methods: This is a retrospective analysis of prospectively maintained data of 10 cases of traumatic transection of main bronchus who underwent bronchial re-implantation at a tertiary thoracic surgery center in India. Patients were divided into two groups based on their total length of hospital stay. Occurrence of postoperative complications and/or hospital stay >7 days were considered poor surgical outcomes. Results: Out of 10 patients, 6 were left main bronchus transections and 4 right main bronchus transections. The male-female ratio was 7:3. Right-sided bronchial injury and higher preoperative Injury Severity Score (ISS) were associated with poor surgical outcomes (P < 0.01). These patients also had significantly higher anastomotic complications, chest tube duration, and prolonged postoperative air leak. Age of the patient, preoperative hemoglobin or albumin levels, and time of referral did not influence the surgical outcomes. Conclusions: Poorer surgical outcomes were observed in patients who had right-sided main bronchus injury and higher ISSs. Time of referral did not influence the outcome. This study is limited by small sample size and retrospective nature. As no single center will have large numbers of this uncommon injury, multicenter pooled data are needed to re-affirm the findings of this study.
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Affiliation(s)
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Sumit Bangeria
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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10
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Lovelock T, Cheng A, Doi A, Zimmet A, Gooi J, Fitzgerald M. Blunt bronchial injury management with veno-venous extracorporeal membrane oxygenation providing a peri-operative 'survival bridge'. Trauma Case Rep 2020; 31:100388. [PMID: 33364296 PMCID: PMC7750647 DOI: 10.1016/j.tcr.2020.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- T Lovelock
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - A Cheng
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - A Doi
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - A Zimmet
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - J Gooi
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - M Fitzgerald
- Trauma Service, The Alfred Hospital, Melbourne, Australia
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11
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Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol 2020; 23:125-138. [PMID: 32417043 PMCID: PMC7296362 DOI: 10.1016/j.cjtee.2020.04.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/15/2020] [Accepted: 04/08/2020] [Indexed: 02/04/2023] Open
Abstract
Physical traumas are tragic and multifaceted injuries that suddenly threaten life. Although it is the third most common cause of death in all age groups, one out of four trauma patients die due to thoracic injury or its complications. Blunt injuries constitute the majority of chest trauma. This indicates the importance of chest trauma among all traumas. Blunt chest trauma is usually caused by motor vehicle accident, falling from height, blunt instrument injury and physical assault. As a result of chest trauma, many injuries may occur, such as pulmonary injuries, and these require urgent intervention. Chest wall and pulmonary injuries range from rib fractures to flail chest, pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries. Following these injuries, patients may present with a simple dyspnea or even respiratory arrest. For such patient, it is important to understand the treatment logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries. This is because only 10% of thoracic trauma patients require surgical operation and the remaining 90% can be treated with simple methods such as appropriate airway, oxygen support, maneuvers, volume support and tube thoracostomy. Adequate pain control in chest trauma is sometimes the most basic and best treatment. With definite diagnosis, the morbidity and mortality can be significantly reduced by simple treatment methods.
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12
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Son SL, Kim WS, Kwon M, Moon YJ. Airway obstruction during pneumonectomy using a single lumen tube: A case report. Medicine (Baltimore) 2020; 99:e19736. [PMID: 32311966 PMCID: PMC7220147 DOI: 10.1097/md.0000000000019736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Endotracheal intubation is an essential step for airway management during general anesthesia. When surgeons carry out thoracic surgery such as pneumonectomy, they usually request lung isolation to secure a clear surgical view. A double lumen endotracheal tube is used for lung isolation in routine thoracic surgeries. PATIENT CONCERNS A 56-year-old man was previously diagnosed with left Aspergilloma, a tuberculosis destroyed lung, and diabetes mellitus. According to his chest x-ray and chest computed tomography, his left lung was nearly collapsed, and the result of a pulmonary function test was severely restricted. The patient's diffusing capacity for carbon monoxide was 63% and predicted postoperative forced expiratory volume in 1 second was 23.5% DIAGNOSES:: Due to his previous history, radiologic findings and laboratory test results, he was diagnosed with left Aspergilloma and tuberculosis destroyed lung. INTERVENTIONS Due to recurrence of Aspergilloma in his left lung, the patient was scheduled for a left pneumonectomy. Since the patient's partial oxygen concentration was adequate despite his left lung being nearly totally collapsed, we thought that we would be capable of performing the pneumonectomy using a single lumen tube (SLT). For a better surgical view, we planned lung isolation via insertion of a SLT deep into the bronchus. OUTCOMES During pneumonectomy, after tracheal suction was performed, we tried a lung recruitment maneuver. Suddenly end-tidal carbon dioxide did not show on the monitor. The patient's blood pressure dropped and heart rate was decreasing. We thought that cardiopulmonary resuscitation was needed and an approximately 2 cm sized hematoma was removed from the endotracheal tube after vigorous suctioning. After getting rid of the hematoma, we changed the single tube to a double lumen tube (DLT). LESSONS This case led us to the conclusion that a DLT should be used for safety when carrying out thoracic surgery. We report a rare case of an airway obstruction using a SLT during pneumonectomy.
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Affiliation(s)
| | - Woo-Shik Kim
- Department of Thoracic and Cardiovascular Surgery, National Medical Center, Seoul, Korea
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13
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Singh S, Garg A, Lamba N, Vishal. Anaesthetic management of intraoperative tracheo-bronchial injury. Respir Med Case Rep 2019; 29:100970. [PMID: 31828009 PMCID: PMC6889322 DOI: 10.1016/j.rmcr.2019.100970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022] Open
Abstract
Intraoperative tracheobronchial injury (TBI) may manifest clinically as pneumothorax, pneumomediastinum, subcutaneous emphysema, cyanosis, and respiratory insufficiency and has serious implications if it remains undetected or is managed improperly. The outcome of such injuries is affected by the extent of the lesion, pulmonary status & the surgical reconstruction undertaken. The recommended airway management of an intraoperative tracheal tear is to bypass the injured side by intubating the healthy bronchus with a single lumen endotracheal tube (ETT) and the use of a bronchial blocker or double lumen endotracheal tube (DLT) and becomes a very challenging situation. We report successful anaesthetic management of an accidental traumatic rupture of the left main bronchus during surgical dissection in an elderly lady of Carcinoma Oesophagus who underwent a Video Assisted Thoracoscopic surgery (VATS), and was managed by one lung ventilation of the contralateral (right) side manipulating the same DLT and lung protective ventilation.
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Affiliation(s)
- Shivinder Singh
- Department of Anesthesia & Intensive Care, Command Hospital, Chandimandir, 134107, India
| | - Anurag Garg
- Department of Anesthesia & Intensive Care, Command Hospital, Chandimandir, 134107, India
| | - Navdeep Lamba
- Department of Anesthesia & Intensive Care, Command Hospital, Chandimandir, 134107, India
| | - Vishal
- Department of Anesthesia & Intensive Care, Command Hospital, Chandimandir, 134107, India
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14
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Saleh ME, Beshir H, Mohammed WH, Sanad M. Tracheobronchial injuries: tertiary center experience. Asian Cardiovasc Thorac Ann 2019; 28:22-28. [PMID: 31779465 DOI: 10.1177/0218492319893822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Tracheobronchial injury is a rare and serious outcome of thoracic trauma. The aim of this study was to describe our experience in the management of tracheobronchial injuries. Methods We reviewed the presentation, line of management, and results of all 23 patients (17 males and 6 females) with a mean age of 27.87 years, who presented with traumatic tracheobronchial injuries and were admitted to the level 3 trauma center of our university emergency hospital over an eight-year period. Results Blunt trauma was the leading cause (73.9%) of injury. Bronchoscopy was routinely performed. A right thoracotomy was carried out in 73.9% of patients. The right main bronchus was the most common site of injury (30.4%), followed by the trachea in 26.1%. Pulmonary resection was undertaken in 5 cases. Three operative mortalities were recorded. Conclusion Tracheobronchial injuries can be treated conservatively or ideally by surgical repair which is the core line of treatment. Surgery has excellent outcomes depending on skillful use of bronchoscopy and the surgeon’s experience of the surgical approach and technique.
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Affiliation(s)
| | - Hatem Beshir
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Egypt.,Department of Cardiothoracic Surgery, Egypt Ministry of Health and Population, Alexandria Directorate, Egypt
| | - Walid H Mohammed
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Egypt
| | - Mohammed Sanad
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Egypt
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15
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Bronchial injuries: a tale of differing presentations. Indian J Thorac Cardiovasc Surg 2019; 35:245-248. [PMID: 33061017 DOI: 10.1007/s12055-018-00783-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/14/2018] [Indexed: 12/26/2022] Open
Abstract
Bronchial disruptions are uncommon but nevertheless grievous injuries and are usually secondary to major thoracic trauma. Although many are associated with other catastrophic injuries causing early mortality, their presentations can be late and they are often difficult to diagnose. Their management is frequently challenging and the ideal course of treatment is not yet clearly defined. Here, we describe two cases of main bronchial injuries presenting to us with post-traumatic collapse lung, albeit with a widely differing post-trauma course. Both required thoracotomy followed by a resection and anastomosis of the disrupted/stenotic segment. Operative results were good with both cases showing a well-expanded lung and no postoperative anastomotic site stenosis during the period of follow-up. Our experience highlights that patients with major bronchial injuries can have varying presentations. High degree of suspicion is necessary for early diagnosis and prompt surgical treatment. Resection of the stenosed/fibrosed segment followed by anastomosis yields good results.
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16
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Lin M, Shen Y, Feng M, Tan L. Is two lung ventilation with artificial pneumothorax a better choice than one lung ventilation in minimally invasive esophagectomy? J Thorac Dis 2019; 11:S707-S712. [PMID: 31080648 DOI: 10.21037/jtd.2018.12.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Two lung ventilation (TLV) with artificial pneumothorax has been introduced into MIE for several years. A few researches have reported its clinical application, and proved its safety and feasibility. However, it is still controversial whether TLV with artificial pneumothorax is a better choice than one lung ventilation (OLV). Obviously, single lumen endotracheal tube is easy for intubation and intraoperative maintenance. Potential problems during intervention include hemodynamic changes, oxygenation, and air embolism. In this paper, present literature is reviewed about two and one lung ventilation in thoracoscopy, looking for clear conclusions for future application.
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Affiliation(s)
- Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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17
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Zarandy E, Counts S, Clemow C. Pneumomediastinum in a College-Aged Soccer Player: A Case Report. Curr Sports Med Rep 2017; 16:71-73. [PMID: 28282351 DOI: 10.1249/jsr.0000000000000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Erik Zarandy
- AnMed Health, Department of Sports Medicine, Anderson, SC
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18
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Abstract
Tracheal and Bronchial injuries are potentially life threatening complications which require urgent diagnosis and therapeutic intervention. They typically occur in association with blunt and penetrating chest trauma although they are increasingly being encountered in patients following endobronchial intervention and percutaneous tracheostomy insertion. Their precise incidence is unknown. Presenting features include dyspnoea, stridor, respiratory and haemodynamic compromise, haemoptysis, surgical emphysema, pneumothorax and persistent significant airleak. There may be other additional injuries to consider in trauma patients with large airway injury. Familiarity with the diagnosis and management of large airway injuries is important for medical teams engaged in emergency medicine, thoracic surgery and medicine, anaesthesia and intensive care. Although early surgical intervention is the mainstay of treatment, endobronchial manoeuvres to seal defects are receiving increasing attention particularly for patients with medical co-morbidities which may contraindicate formal surgery or transfer or where local surgical expertise is not available.
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19
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Abstract
Thoracic injuries account for 25% of all civilian deaths. Blunt force injuries are a subset of thoracic injuries and include injuries of the tracheobronchial tree, pleural space, and lung parenchyma. Early identification of these injuries during initial assessment and resuscitation is essential to reduce associated morbidity and mortality rates. Management of airway injuries includes definitive airway control with identification and repair of tracheobronchial injuries. Management of pneumothorax and hemothorax includes pleural space drainage and control of ongoing hemorrhage, along with monitoring for complications such as empyema and chylothorax. Injuries of the lung parenchyma, such as pulmonary contusion, may require support of oxygenation and ventilation through both conventional and nonconventional mechanical ventilation strategies. General strategies to improve pulmonary function and gas exchange include balanced fluid resuscitation to targeted volume-based resuscitation end points, positioning therapy, and pain management.
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20
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Chaudhry I, Aldulaijan FW, Alhajji Z, Cheema A, Mutairi H. Late Intrathoracic Tracheal Stricture After Blunt Chest Trauma: A Rare Life-Threatening Condition. Ann Thorac Surg 2016; 101:766-9. [PMID: 26777938 DOI: 10.1016/j.athoracsur.2015.04.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 04/19/2015] [Accepted: 04/23/2015] [Indexed: 11/15/2022]
Abstract
Tracheal injury after blunt chest trauma is a rare but life-threatening condition. If diagnosed and treated early, the outcome is excellent. We report a case of an 18-year-old man who sustained a fracture of the right femur in a traffic accident. He underwent operation under spinal anesthesia and was discharged home after 2 weeks. Six weeks later, he was readmitted with acute respiratory distress, stridor, and drowsiness. Arterial blood gas analysis showed hypercarbia (PCO2 of 80 mm Hg; PO2 of 60 mm Hg). He was intubated with difficulty and ventilated. A computed tomographic (CT) scan of the chest showed a very tight supracarinal tracheal stricture. Emergency surgical resection of the tracheal stricture was performed, and an end-to-end anastomosis was fashioned. The patient had an excellent recovery.
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Affiliation(s)
- Ikram Chaudhry
- Division of Thoracic Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
| | - Fozan W Aldulaijan
- Division of Thoracic Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Zahra Alhajji
- Division of Thoracic Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ahsan Cheema
- Division of Thoracic Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Hadi Mutairi
- Division of Thoracic Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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21
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Abstract
OBJECTIVE Recent technical advances, including the routine use of CT thin sections and techniques such as 2D minimum-intensity-projection and 3D volume images, have increased our ability to detect large airways diseases. Furthermore, dedicated CT protocols allow the evaluation of dynamic airway dysfunction. CONCLUSION With diseases of the large airways more commonly seen in daily practice, it is important that radiologists be familiar with the appearances, differential diagnosis, and clinical implications of these entities.
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22
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Abstract
Tracheobronchial avulsion resulting from blunt trauma is a very rare and serious condition, mostly due to high-speed traffic crashes. In this article, we briefly report the case of an 18-year-old man who was injured in a car accident and because of massive persistent air leakage (despite appropriate chest tube drainage), deemed to have a deep tracheobronchial injury. Due to a rapid drop in the patient's O2 saturation, he underwent an anterolateral thoracotomy. Endotracheal intubation was performed under direct visualization. The right mainstem bronchus was disrupted from the carina with a 1.5-cm stump remaining on the carina, and the remainder was crushed to the origin of the right superior lobe bronchus. Hence, a right superior lobectomy was performed and the postoperative course was uneventful.
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Affiliation(s)
- Rahim Mahmodlou
- Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Nariman Sepehrvand
- Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran
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23
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Kaur M, Gupta B, Sinha C, Shende S. A report on a case of accidental neck strangulation and its anesthetic concerns. Anesth Essays Res 2015; 4:120-2. [PMID: 25885245 PMCID: PMC4173344 DOI: 10.4103/0259-1162.73522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Manpreet Kaur
- Department of Anaesthesia, All India Institute of Medical Sciences, J.P.N.A. Trauma Centre, New Delhi, India
| | - Babita Gupta
- Department of Anaesthesia, All India Institute of Medical Sciences, J.P.N.A. Trauma Centre, New Delhi, India
| | - Chandni Sinha
- Department of Anaesthesia, All India Institute of Medical Sciences, J.P.N.A. Trauma Centre, New Delhi, India
| | - Seema Shende
- Department of Anaesthesia, All India Institute of Medical Sciences, J.P.N.A. Trauma Centre, New Delhi, India
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24
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Isolated tracheal injury after whiplash. J Acute Med 2015. [DOI: 10.1016/j.jacme.2015.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Altoos R, Carr R, Chung J, Stern E, Nevrekar D. Selective Common and Uncommon Imaging Manifestations of Blunt Nonaortic Chest Trauma: When Time is of the Essence. Curr Probl Diagn Radiol 2015; 44:155-66. [DOI: 10.1067/j.cpradiol.2014.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 11/22/2022]
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26
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Abstract
Thoracic injuries account for 25% of all civilian deaths. Blunt force injuries are a subset of thoracic injuries and include injuries of the tracheobronchial tree, pleural space, and lung parenchyma. Early identification of these injuries during initial assessment and resuscitation is essential to reduce associated morbidity and mortality rates. Management of airway injuries includes definitive airway control with identification and repair of tracheobronchial injuries. Management of pneumothorax and hemothorax includes pleural space drainage and control of ongoing hemorrhage, along with monitoring for complications such as empyema and chylothorax. Injuries of the lung parenchyma, such as pulmonary contusion, may require support of oxygenation and ventilation through both conventional and nonconventional mechanical ventilation strategies. General strategies to improve pulmonary function and gas exchange include balanced fluid resuscitation to targeted volume-based resuscitation end points, positioning therapy, and pain management.
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Affiliation(s)
- John J. Gallagher
- John J. Gallagher is Clinical Nurse Specialist/Trauma Program Manager, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
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27
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Pneumomediastinum in blunt chest trauma: a case report and review of the literature. Case Rep Emerg Med 2014; 2014:685381. [PMID: 25114811 PMCID: PMC4119635 DOI: 10.1155/2014/685381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 06/24/2014] [Indexed: 02/07/2023] Open
Abstract
Blunt trauma is the most common mechanism of injury in patients with pneumomediastinum and may occur in up to 10% of patients with severe blunt thoracic and cervical trauma. In this case report we present a 24-year-old man with pneumomediastinum due to blunt chest trauma after jumping from a bridge into a river. He complained of persistent retrosternal pain with exacerbation during deep inspiration. Physical examination showed only a slight tenderness of the sternum and the extended Focused Assessment with Sonography for Trauma (e-FAST) was normal. Pneumomediastinum was suspected by chest X-ray and confirmed by computed tomography, which showed a lung contusion as probable cause of the pneumomediastinum due to the "Mackling effect." Sonographic findings consistent with pneumomediastinum, like the "air gap" sign, are helpful for quick bedside diagnosis, but the diagnostic criteria are not yet as well established as for pneumothorax. This present case shows that despite minimal findings in physical examination and a normal e-FAST a pneumomediastinum is still possible in a patient with chest pain after blunt chest trauma. Therefore, pneumomediastinum should always be considered to prevent missing major aerodigestive injuries, which can be associated with a high mortality rate.
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28
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Prokakis C, Koletsis EN, Dedeilias P, Fligou F, Filos K, Dougenis D. Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg 2014; 9:117. [PMID: 24980209 PMCID: PMC4104740 DOI: 10.1186/1749-8090-9-117] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/23/2014] [Indexed: 12/17/2022] Open
Abstract
Airway injuries are life threatening conditions. A very little number of patients suffering air injuries are transferred live at the hospital. The diagnosis requires a high index of suspicion based on the presence of non-specific for these injuries symptoms and signs and a thorough knowledge of the mechanisms of injury. Bronchoscopy and chest computed tomography with MPR and 3D reconstruction of the airway represent the procedures of choice for the definitive diagnosis. Endotracheal intubation under bronchoscopic guidance is the key point to gain airway control and appropriate ventilation. Primary repair with direct suture or resection and an end to end anastomosis is the treatment of choice for patients suffering from tracheobronchial injuries (TBI). The surgical approach to the injured airway depends on its location. Selected patients, mainly with iatrogenic injuries, can be treated conservatively as long as the injury is small (<2 cm), a secure and patent airway and adequate ventilation are achieved, and there are no signs of sepsis. Patients with delayed presentation airway injuries should be referred for surgical treatment. Intraoperative evaluation of the viability of the lung parenchyma beyond the site of stenosis/obstruction is mandatory to avoid unnecessary lung resection.
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Affiliation(s)
- Christos Prokakis
- Department of Cardiothoracic Surgery, University of Patras, School of Medicine, Patras, Greece
| | - Efstratios N Koletsis
- Department of Cardiothoracic Surgery, University of Patras, School of Medicine, Patras, Greece
| | | | - Fotini Fligou
- Department of Anesthesiology and Intensive Care, University of Patras, School of Medicine, Patras, Greece
| | - Kriton Filos
- Department of Anesthesiology and Intensive Care, University of Patras, School of Medicine, Patras, Greece
| | - Dimitrios Dougenis
- Department of Cardiothoracic Surgery, University of Patras, School of Medicine, Patras, Greece
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29
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Alassal MA, Ibrahim BM, Elsadeck N. Traumatic intrathoracic tracheobronchial injuries: a study of 78 cases. Asian Cardiovasc Thorac Ann 2014; 22:816-23. [PMID: 24585278 DOI: 10.1177/0218492313516777] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Tracheobronchial injuries are encountered with increasing frequency because of improvements in pre-hospital care. We reviewed our experience of these injuries to determine how to better recognize them and facilitate their correct management. METHODS Patients with traumatic non-iatrogenic intrathoracic tracheobronchial injuries managed in 2 tertiary centers in Saudi Arabia between 2000 and 2012, were studied. Clinical presentation, diagnostic evaluation, management, and outcome were reviewed. RESULTS 78 patients with tracheobronchial injuries were included in this study. They were divided into 2 groups according to the management strategy. Forty-seven patients who were managed conservatively, and 31 underwent surgery. Surgery allowed shorter intensive care unit and hospital stays; otherwise, the results were comparable between the two groups. CONCLUSIONS Early recognition and expedient appropriate management are essential in these potentially lethal injuries. Operative management can be achieved with acceptable mortality, and conservative treatment should be considered as a valuable alternative to the well-established surgical treatment.
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Affiliation(s)
- Mohamed A Alassal
- Prince Salman Heart Center, King Fahd Medical City, Riyadh, Saudi Arabia Cardiothoracic Surgery Department, Banha University, Egypt
| | | | - Nabil Elsadeck
- Cardiothoracic Surgery Department, Zagazig University, Egypt Cardiothoracic Surgery Department, Asir Central Hospital, Saudi Arabia
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30
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Chhabra A, Rudingwa P, Panneer Selvam SR. Pathophysiology and management of Airway Trauma. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2013.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Hwang JJ, Kim YJ, Cho HM, Lee TY. Traumatic tracheobronchial injury: delayed diagnosis and treatment outcome. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:197-201. [PMID: 23772407 PMCID: PMC3680605 DOI: 10.5090/kjtcs.2013.46.3.197] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 11/08/2012] [Accepted: 11/16/2012] [Indexed: 12/20/2022]
Abstract
Background Most traumatic tracheobronchial injuries are fatal and result in death. Some milder cases are not life threatening and are often missed at the initial presentation. Tracheobronchial rupture is difficult to diagnose in the evaluation of severe multiple trauma patients. We reviewed the traumatic tracheobronchial injuries at Konyang University and Eulji University Hospital and analyzed the clinical results. Materials and Methods From January 2001 to December 2011, 23 consecutive cases of traumatic tracheobronchial injury after blunt trauma were reviewed retrospectively. We divided them into two groups by the time to diagnosis: group I was defined as the patients who were diagnosed within 48 hours from trauma and group II was the patients who diagnosed 48 hours after trauma. We compared the clinical parameters of the two groups. Results There was no difference in the age and gender between the two groups. The most common cause was traffic accidents (56.5%). The Injury Severity Score (ISS) was 19.6 in group I and 27.5 in group II (p=0.06), respectively. Although the difference in the ISS was not statistically significant, group II tended toward more severe injuries than group I. Computed tomography was performed in 22 cases and tracheobronchial injury was diagnosed in 5 in group I and 6 in group II, respectively (p=0.09). Eighteen patients underwent surgical treatment and all four cases of lung resection were exclusively performed in group II (p=0.03). There were two mortality cases, and the cause of death was shock and sepsis. Conclusion We believe that close clinical observation with suspicion and rigorous bronchoscopic evaluation are necessary to perform diagnosis earlier and preserve lung parenchyma in tracheobronchial injuries from blunt trauma.
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Affiliation(s)
- Jung Joo Hwang
- Department of Thoracic and Cardiovascular Surgery, Eulji University School of Medicine, Korea
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32
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Retrograde Instillation of Methylene Blue in the Difficult Diagnosis of BPF. Case Rep Med 2012; 2012:714746. [PMID: 23091498 PMCID: PMC3471436 DOI: 10.1155/2012/714746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 08/24/2012] [Accepted: 09/10/2012] [Indexed: 12/19/2022] Open
Abstract
We report two cases in which we were able to diagnose bronchopleural fistula through retrograde methylene blue instillation during bronchoscopy. In the first case, methylene blue was injected through an abdominal drain, followed by air instillation and detected in the left bronchial tree, demonstrating the presence of a fistula in the lingula's bronchus. In the second case, methylene blue was injected into a pleural drain, through a breach on a surgical suture and detected in the right bronchial tree, demonstrating the presence of a fistula in the right inferior bronchus. The retrograde instillation of methylene blue, through a drain in the abdomen or the thoracic wall, is a safe, cheap, and practical method that allows the bronchoscopist to identify the presence of a fistula and, more importantly, to identify the exact point on the bronchial tree where a fistula is located. This provides the possibility of sealing the fistula with a variety of devices. It is our opinion that this procedure should be considered a primary method of diagnosis when a bronchopleural fistula is suspected and a drain on the thoracic or abdominal wall is positioned such that effusions are able to drain.
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33
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Gupta B, Sinha C, Kumar A, Dey C, Ramchandani S, Kumar S, Sawhney C, Misra MC. Perioperative management of laryngotracheobronchial injury: our experience in a level 1 trauma centre. Eur J Trauma Emerg Surg 2012; 38:553-61. [PMID: 26816258 DOI: 10.1007/s00068-012-0199-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 05/08/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE Laryngotracheobronchial injuries (LTBI) are serious injuries because of their consequences in terms of ventilation, coupled with the severity of other injuries associated with them. We share our experience in managing these patients perioperatively in our level 1 trauma centre. METHODS A retrospective analysis of the records of 30 patients with LTBI who presented at Jai Prakash Narayan Apex Trauma Center (JPNATC) from December 2007 to February 2011 was done. The demographics, mechanism of injury, clinical presentation, diagnostic modalities, anaesthetic management and outcome in these patients were reviewed. RESULTS Intrathoracic location of the injury and Injury Severity Score (ISS) had a direct correlation with the outcome of the patients. The overall mortality was 6.7 %. CONCLUSION Meticulous examination, details about the mechanism of injury, careful diagnostic evaluation, and skilful airway and surgical management are necessary for a better outcome in patients with airway injuries. A high degree of suspicion in occult injuries and liberal use of a fibreoptic bronchoscope aids diagnosis and management. Prompt airway management in the pre-hospital setting before transfer to a higher level trauma centre ensures better outcomes.
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Affiliation(s)
- B Gupta
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India. .,, I-22 (Ground Floor), South City II, Gurgaon, Haryana, India.
| | - C Sinha
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - A Kumar
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - C Dey
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - S Ramchandani
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S Kumar
- Department of Surgery, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - C Sawhney
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - M C Misra
- Department of Surgery, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Ku CM, Ong S, Poopalalingam R. The diagnosis and management of a persistent pneumothorax. J Cardiothorac Vasc Anesth 2008; 23:369-72. [PMID: 18834799 DOI: 10.1053/j.jvca.2008.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Chih Min Ku
- Department of Anesthesia, Singapore General Hospital, Singapore.
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35
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Abstract
Tracheobronchial injuries (TBI) can be challenging to diagnose, manage, and definitively treat. They encompass a heterogeneous group of injuries that are often associated with other injuries. Although relatively rare, diagnosis and treatment of TBI often requires skillful and creative airway management, careful diagnostic evaluation, and operative repairs that are often resourceful and necessarily unique to the given injury. An experienced surgeon with a high level of suspicion and the liberal use of bronchoscopy constitute the major tools necessary for diagnosing and treating these injuries. Most TBI can be repaired primarily using a tailored surgical approach and techniques specific to the injury. Associated injuries are common, and surgeons must be knowledgeable in treating a wide variety of physiologic abnormalities, especially those involving the chest wall and lung parenchyma, if a successful outcome is to be achieved in the management of these often challenging patients.
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Affiliation(s)
- Scott B Johnson
- Division of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
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36
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Glazer ES, Meyerson SL. Delayed presentation and treatment of tracheobronchial injuries due to blunt trauma. JOURNAL OF SURGICAL EDUCATION 2008; 65:302-308. [PMID: 18707665 DOI: 10.1016/j.jsurg.2008.06.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 06/16/2008] [Accepted: 06/19/2008] [Indexed: 05/26/2023]
Abstract
BACKGROUND Blunt thoracic trauma that results in tracheobronchial injury is difficult to diagnose. Many injuries are catastrophic and result in early mortality. Others are not immediately life threatening and are missed at initial presentation. Some of those injuries will later become symptomatic and will require medical attention. Ideal treatment in that situation is not yet clearly defined. OBJECTIVES The objective is to review the current literature of delayed diagnoses of traumatic tracheobronchial injuries, their management, and the results of the most common repair methods. An interesting case report from this institution is presented as well. DESIGN A Medline search of the English literature of delayed presentation of tracheobronchial injuries over the past 10 years was performed. Delayed diagnosis was defined as injuries not identified during the initial hospitalization. RESULTS The median time from initial presentation to diagnosis was 6 months. Dyspnea (56%) and pneumonia (39%) were the most common complaints. No difference in complications was observed between parenchymal sparing procedures and resections. CONCLUSIONS Despite delays in presentation and the radiographic appearance of destroyed distal lung, proximal injuries can often be repaired without sacrifice of distal lung parenchyma. Bronchial sleeve resections or end-to-end anastomosis can be performed safely in most situations.
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Affiliation(s)
- Evan S Glazer
- Department of Surgery, University of Arizona, Tucson, Arizona 85724, USA
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37
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Martel G, Al-Sabti H, Mulder DS, Sirois C, Evans DC. Acute Tracheoesophageal Burst Injury After Blunt Chest Trauma: Case Report and Review of the Literature. ACTA ACUST UNITED AC 2007; 62:236-42. [PMID: 17215763 DOI: 10.1097/01.ta.0000243042.47334.5e] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Guillaume Martel
- Department of Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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38
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Abstract
Tracheobronchial injuries from trauma can be life threatening. We present a case report of a 23-year-old man who suffered a left main bronchus transection after a motorbike accident. The diagnostic and management issues surrounding tracheobronchial injuries are reviewed. Early diagnosis and treatment lead to the best outcome, with almost complete return of pulmonary function.
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Affiliation(s)
- Edward H N Wong
- Department of Surgery, Austin Hospital, Melbourne, Victoria, Australia.
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39
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Graham J, Davidson AJ. Anaesthesia for major orthopaedic surgery in a child with an acute tracheobronchial injury. Anaesth Intensive Care 2006; 34:88-92. [PMID: 16494157 DOI: 10.1177/0310057x0603400103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 12-year-old boy presented after a motorbike accident with mediastinal and cervical emphysema but no pneumothorax, minor head injury and several fractures including a comminuted open leg fracture. The child had no signs of respiratory compromise and was stable. The presumed tracheobronchial injury was managed conservatively. To avoid general anaesthesia and the risks associated with intubation and ventilation, urgent surgery for correction of his orthopaedic injuries was successfully conducted under spinal, epidural and intravenous regional anaesthesia. The surgical and anaesthetic management of tracheobronchial injury is complex and controversial.
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Affiliation(s)
- J Graham
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria
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40
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Katsaragakis S, Stamou KM, Androulakis G. Independent lung ventilation for asymmetrical chest trauma: effect on ventilatory and haemodynamic parameters. Injury 2005; 36:501-4. [PMID: 15755431 DOI: 10.1016/j.injury.2004.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2004] [Indexed: 02/02/2023]
Abstract
Complex thoracic injuries significantly alter the lung mechanics. There appears to be severe ventilation-perfusion inequality that is enhanced by the asymmetrical compliance of the injured areas. In cases of unilateral massive air leaks large tidal volumes are needed to deliver adequate air volume to the injured lung. In such cases, mechanical ventilation via a standard tracheal tube will direct a large fraction of the tidal volume to the less affected areas. An alternative means of ventilating these patients is the application of independent lung ventilation through a double lumen tracheal tube and the use of two separate ventilators. Two such cases are presented with emphasis given on the ventilatory and haemodynamic changes that were recorded.
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Affiliation(s)
- Stylianos Katsaragakis
- Surgical Intensive Care Unit, 1st Department of Surgery, Hippokrateion Hospital, 20 Potamianou Street, 115 28 Athens, Greece
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Mallow S, Rebuck JA, Osler T, Ahern J, Healey MA, Rogers FB. Do proton pump inhibitors increase the incidence of nosocomial pneumonia and related infectious complications when compared with histamine-2 receptor antagonists in critically ill trauma patients? ACTA ACUST UNITED AC 2004; 61:452-8. [PMID: 15475094 DOI: 10.1016/j.cursur.2004.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Proton pump inhibitors (PPI) may increase the risk of nosocomial pneumonia caused by profound irreversible gastric acid suppression. The study purpose was to characterize differences in nosocomial pneumonia and related infections in trauma patients administered either histamine2-receptor antagonists (H2RA) or PPI. METHODS Observational evaluation of consecutive critically ill adult trauma patients administered either omeprazole or famotidine during a 22-month period. Nosocomial infection was evaluated daily based on published CDC definitions. RESULTS Eighty of 269 patients fulfilled study criteria. The PPI group (n = 40) exhibited increased baseline risk for infection, demonstrated by higher ISS (p = 0.020), more chest tube placements (p = 0.031), and increased chest trauma (p = 0.025). Overall number of patients infected per group included 33% and 40% of patients administered PPI and H2RA, respectively (p = 0.64). Despite baseline differences, the incidence of nosocomial infection was similar (p = 0.87), and extrapolation of pneumonia based on 1000 patient days revealed a ratio 51.7 vs 52.2 in the PPI vs H2RA groups, respectively, which was not significant (p = 0.99). CONCLUSIONS Proton pump inhibitor administration does not increase risk of nosocomial pneumonia or other nosocomial infections compared with H2RA therapy in the critically ill trauma patient.
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Affiliation(s)
- Stephanie Mallow
- Department of Pharmacotherapy, Fletcher Allen Health Care, Burlington, Vermont 05401, USA
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Wu MH, Tsai YF, Lin MY, Hsu IL, Fong Y. Complete laryngotracheal disruption caused by blunt injury. Ann Thorac Surg 2004; 77:1211-5. [PMID: 15063237 DOI: 10.1016/j.athoracsur.2003.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2003] [Indexed: 11/28/2022]
Abstract
BACKGROUND We reviewed the clinical courses and evaluated the surgical results of 7 patients with complete laryngotracheal disruption caused by blunt injury. METHODS Seven patients with complete laryngotracheal disruption caused by blunt injury were successfully treated in a 13-year period. Six of the seven incidents involved men younger than 30 years on motorcycles. All but one had intact cutaneous tissue of the neck. Six of seven laryngotracheal disruptions were at the cricotracheal junction and the other was at the junction of second and third tracheal ring. In the emergency departments, 4 of these 7 patients underwent endotracheal intubation and three others underwent tracheostomy after failed intubation. Two of 7 patients underwent delayed surgery (posttrauma day 3 and day 5) because of delayed diagnosis. All patients underwent laryngotracheoplasty with (n = 3) or without (n = 4) concomitant tracheostomy. RESULTS Total hospital stays ranged from 9 to 28 days (average 15 days). Intensive care unit stay ranged from 2 to 10 days (average 5.8 days). All 7 patients had paralysis of bilateral vocal cords that were revealed by postoperative bronchoscopy. In 3 patients who underwent concomitant tracheostomy, the tracheostomy tubes were removed within 3 to 5 months after surgery. In the other 4 patients who underwent laryngotracheoplasty only, the endotracheal tube was used as an airway support for 2 to 6 days (average 3.5 days). All patients had patent airways. Vocal cord function partially recovered in one side (n = 6) or both sides (n = 1). Their voices were audible but still husky 5 months or 1 year later. CONCLUSIONS Complete laryngotracheal disruption can be treated by laryngotracheoplasty with or without concomitant tracheostomy, and phonation can be partially recovered.
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Affiliation(s)
- Ming-Ho Wu
- Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
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