1
|
Song Z, Jiang Y, Tan J, Gu L, Cai J, Zhou Y. Conservative management of a rare case of post thyroidectomy tracheal injury with coagulation abnormalities. Heliyon 2024; 10:e28737. [PMID: 38586347 PMCID: PMC10998211 DOI: 10.1016/j.heliyon.2024.e28737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
Background Tracheal injury is a rare but potentially serious acute complication of endotracheal intubation. Very few cases of tracheal injury associated with coagulation abnormalities have been reported in the literature. We present a rare case of a patient presenting with tracheal injury in combination with coagulation abnormalities following thyroidectomy. Case presentation A 58-year-old woman with a history of postoperative chemotherapy for breast cancer, gastric polyps, multiple colonic polyps, esophageal papillary adenomas, and thyroid adenomas presented with dyspnea following 10 ml hemoptysis on the third day after thyroidectomy; she was admitted to the intensive care unit and underwent tracheal intubation for maintaining the airway. Subsequent bronchoscopy revealed a nodular red neoplasm 5-cm from the carina in the trachea obstructing part of the lumen, with a small amount of fresh hemorrhage on the surface. Tracheal injury was considered the preliminary diagnosis. Fiberoptic bronchoscope guided tracheal intubation helped prevent rupture of the tumor, and the cannula was properly inflated to arrest the bleeding while blocking the lower part of the trachea. An emergency surgical evacuation of the cervical hematoma was performed for managing postoperative bleeding. The patient demonstrated persistent pancytopenia despite frequent transfusions. Laboratory examination results revealed abnormal coagulation parameters, anemia, and hepatic dysfunction. Following a multidisciplinary team discussion, pituitrin for hemostasis, tranexamic acid for strengthening hemostasis treatment, and nutritional support and anti-infection treatment were initiated. Endotracheal tube cuff inflation was performed to compress the bleeding site. Complete resolution of the subcutaneous hematoma was observed nine days after the tracheal injury; bronchoscopy revealed residual ecchymosis in the airway hematoma with no evidence of obstruction. Conclusion Conservative management of tracheal injury limited to the mucosa or submucosa without significant amount of active bleeding using endotracheal intubation is considered a practical and effective approach. Successful management was ensured by appropriate clinical suspicion, early multidisciplinary team discussion, and prompt diagnosis and interventions.
Collapse
Affiliation(s)
- Zhenghuan Song
- Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, PR China
| | - Yueyi Jiang
- The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jing Tan
- Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, PR China
| | - Lianbing Gu
- Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, PR China
| | - Jiaqin Cai
- Xuzhou Medical University, Xuzhou, PR China
| | - Yihu Zhou
- The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, PR China
| |
Collapse
|
2
|
Cao JB, Zhu ST, Huang XS, Wang XY, Wu ML, Li X, Liu FL, Chen L, Zheng YT, Wang JH. Mast cell degranulation-triggered by SARS-CoV-2 induces tracheal-bronchial epithelial inflammation and injury. Virol Sin 2024:S1995-820X(24)00027-0. [PMID: 38458399 DOI: 10.1016/j.virs.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024] Open
Abstract
SARS-CoV-2 infection-induced hyper-inflammation is a key pathogenic factor of COVID-19. Our research, along with others', has demonstrated that mast cells (MCs) play a vital role in the initiation of hyper-inflammation caused by SARS-CoV-2. In previous study, we observed that SARS-CoV-2 infection induced the accumulation of MCs in the peri-bronchus and bronchioalveolar-duct junction in humanized mice. Additionally, we found that MC degranulation triggered by the spike protein resulted in inflammation in alveolar epithelial cells and capillary endothelial cells, leading to subsequent lung injury. The trachea and bronchus are the routes for SARS-CoV-2 transmission after virus inhalation, and inflammation in these regions could promote viral spread. MCs are widely distributed throughout the respiratory tract. Thus, in this study, we investigated the role of MCs and their degranulation in the development of inflammation in tracheal-bronchial epithelium. Histological analyses showed the accumulation and degranulation of MCs in the peri-trachea of humanized mice infected with SARS-CoV-2. MC degranulation caused lesions in trachea, and the formation of papillary hyperplasia was observed. Through transcriptome analysis in bronchial epithelial cells, we found that MC degranulation significantly altered multiple cellular signaling, particularly, leading to upregulated immune responses and inflammation. The administration of ebastine or loratadine effectively suppressed the induction of inflammatory factors in bronchial epithelial cells and alleviated tracheal injury in mice. Taken together, our findings confirm the essential role of MC degranulation in SARS-CoV-2-induced hyper-inflammation and the subsequent tissue lesions. Furthermore, our results support the use of ebastine or loratadine to inhibit SARS-CoV-2-triggered degranulation, thereby preventing tissue damage caused by hyper-inflammation.
Collapse
Affiliation(s)
- Jian-Bo Cao
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou 510530, China; School of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Shu-Tong Zhu
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou 510530, China
| | - Xiao-Shan Huang
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou 510530, China
| | - Xing-Yuan Wang
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou 510530, China
| | - Meng-Li Wu
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou 510530, China
| | - Xin Li
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou 510530, China
| | - Feng-Liang Liu
- Key Laboratory of Bioactive Peptides of Yunnan Province, Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China
| | - Ling Chen
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou 510530, China
| | - Yong-Tang Zheng
- Key Laboratory of Bioactive Peptides of Yunnan Province, Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China.
| | - Jian-Hua Wang
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou 510530, China; University of Chinese Academy of Sciences, Beijing 101408, China.
| |
Collapse
|
3
|
Haraguchi N, Naito Y, Shibasaki M, Sawa T. Tracheal injury diagnosed by a sudden increase in end-tidal carbon dioxide levels during mediastinoscopic subtotal esophagectomy: a case report. JA Clin Rep 2024; 10:11. [PMID: 38349592 PMCID: PMC10864238 DOI: 10.1186/s40981-024-00695-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Mediastinoscopic surgery for esophageal cancer facilitates early postoperative recovery. However, it can occasionally cause serious complications. Here, we present the case of a patient with a tracheal injury diagnosed by a sudden increase in end-tidal carbon dioxide (EtCO2) during mediastinoscopic subtotal esophagectomy. CASE PRESENTATION A 52-year-old man diagnosed with esophageal cancer was scheduled to undergo mediastinoscopic subtotal esophagectomy. During the mediastinoscopic procedure, the EtCO2 level suddenly increased above 200 mmHg, and the blood pressure dropped below 80 mmHg. We immediately asked the operator to stop insufflation and found a tracheal injury on the right side of the trachea near the carina by bronchoscopy. The endotracheal tube was replaced with a double-lumen tube, and the trachea was repaired via right thoracotomy. There were no further intraoperative complications. After surgery, the patient was extubated and admitted to the intensive care unit. CONCLUSIONS Monitoring EtCO2 levels and close communication with the operator is important for safely managing sudden tracheal injury during mediastinoscopic esophagectomy.
Collapse
Affiliation(s)
- Natsuho Haraguchi
- Department of Anesthesiology, Fukuchiyama City Hospital, 231 Atsunaka-Cho, Fukuchiyama, Kyoto, 620-8505, Japan
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yoshifumi Naito
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kamigyo-Ku, Kyoto, 602-8566, Japan.
| | - Masayuki Shibasaki
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
| |
Collapse
|
4
|
Ma Y, Yue T, He Q. Tracheal injury following robotic thyroidectomy: A literature review of epidemiology, etiology, diagnosis, and treatment and 3 case reports. Asian J Surg 2024; 47:83-88. [PMID: 37879990 DOI: 10.1016/j.asjsur.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/06/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
Robotic thyroidectomy is one of the most advanced surgical procedures used to manage benign and malignant thyroid nodules. However, complication risks such as tracheal injury still exists. Tracheal injury in robotic thyroidectomy is difficult to detect and is one of the life-threatening complications. This study reviews the current literature on the tracheal injury following robotic thyroidectomy and also discusses our findings on 2060 cases of robotic thyroidectomy via Da Vinci Surgical System performed in our department and finally presents 3 cases treated in our center. PubMed and Web of Science database were searched using Medical Subject Headings (Mesh) related to "tracheal injury" and "robotic thyroidectomy". The search was conducted without publication date limits. We reviewed the literature and summarized common causes, diagnosis and therapeutic options of tracheal injury in robotic thyroidectomy, which has been described in comparison studies or retrospective studies. Tracheal injury is often diagnosed when patients suffer from dyspnea and usually leads to severe postoperative consequences. Tracheal injury can be suspected in all patients having subcutaneous emphysema, pneumomediastinum, pneumothorax or dyspnea after robotic thyroidectomy. Tracheoscopy is necessary to determine the location and size of tracheal injury. In patients whose condition is stable and the injury is contained, conservative treatment is feasible. Certainly, primary closure or tracheotomy is necessary for patients with serious respiratory difficulty or pneumothorax.
Collapse
Affiliation(s)
- Yunhan Ma
- Department of General Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong, 250000, China
| | - Tao Yue
- Department of General Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong, 250000, China
| | - Qingqing He
- Department of General Surgery, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong, 250000, China.
| |
Collapse
|
5
|
Malkoc A, Wong S, Gnanadev R, Phan A, Farrokhi H, Nguyen DT, Wong DT. Tracheal ulcer development from high volume, low-pressure cuffed endotracheal tubes. Am J Otolaryngol 2024; 45:104098. [PMID: 37979216 DOI: 10.1016/j.amjoto.2023.104098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Iatrogenic injury to the larynx, particularly the vocal cords from prolonged intubation, has been well-studied; however, tracheal injuries are rarely reported. This study investigates the effectiveness of cuffed, high-volume, low-pressure endotracheal tubes in preventing the development of tracheal ulcers in intubated subjects. METHODS A retrospective, IRB-approved review was performed on 1355 subjects who underwent percutaneous tracheostomy from 2002 to 2018. The presence and severity of tracheal ulcers were collected using documentation and photos during percutaneous tracheostomy placement. Primary outcome measures included: the length of time on a ventilator until tracheostomy (LOVT), length of hospitalization (LOH), and mortality in relationship to the severity of the tracheal injury. Data was reported as n (%) and median (IQR). The differences in means between groups were analyzed by ANOVA and Chi-square test with an alpha of 0.05. RESULTS 206 subjects met the inclusion criteria; 65 subjects had an absence of tracheal injury, and 141 subjects developed tracheal ulcers. Subjects with tracheal ulcers were grouped by the following severity scale: no ulcer; mild ulcer (minimal mucosal erosion with exudate); moderate ulcer (mucosal erosion); and severe (tracheal ring exposure). There were no statistically significant differences in age (p = 0.99), gender (p = 0.83), BMI (p = 0.44), LOH (p = 0.88), LOVT (p = 0.93), and mortality (p = 0.306) between subjects with differing severity of ulcers. The average annual incidence of clinically significant ulcers (moderate and severe) was 2.2 %. CONCLUSIONS The lack of statistical correlation between the duration of intubation and tracheal ulcer severity, along with a low annual incidence of tracheal ulcers, supports the improved safety of high-volume, low-pressure cylindrical, cuffed endotracheal tubes. This study is among the first to specifically focus on injuries at the level of the cuff and tip of endotracheal tubes with implications in preventive measures and potential product design changes.
Collapse
Affiliation(s)
- Aldin Malkoc
- Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA
| | - Stephanie Wong
- Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA; California University of Science and Medicine, 1501 Violet Street, Colton, CA 92324, USA
| | - Raja Gnanadev
- Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA
| | - Alexander Phan
- Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA
| | - Haley Farrokhi
- University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Danny T Nguyen
- Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA
| | - David T Wong
- Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA.
| |
Collapse
|
6
|
Li A, Gu L, He C, Li Y, Peng M, Liao J, Xiao R, Xu L, Guo S. GATA6 promotes fibrotic repair of tracheal injury through NLRP3 inflammasome-mediated epithelial pyroptosis. Int Immunopharmacol 2023; 123:110657. [PMID: 37531826 DOI: 10.1016/j.intimp.2023.110657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023]
Abstract
Tracheal injury is a challenging emergency condition that is characterized by the abnormal repair of the trachea. GATA6, a well-established transcription factor, plays a crucial role in tissue injury and epithelial regenerative repair. This study aims to evaluate the role of GATA6 in NF-κB-mediated NLRP3 inflammasome activation and pyroptosis after tracheal injury. Tracheal tissues and serum samples were collected from clinical patients and a rat model of tracheal injury. Upon GATA6 knockdown or overexpression, BEAS-2B and rat tracheal epithelial (RTE) cells were treated with lipopolysaccharides and nigericin before being co-cultured with primary tracheal fibroblasts. The changes of NLRP3 inflammasome activation and pyroptosis and their underlying mechanisms were detected. Additionally, the role of GATA6 downregulation in tracheal injury was verified in rats. GATA6 expression and NLRP3 inflammasome activation were upregulated following tracheal injury in the epithelium of granulation tissues. GATA6 silencing inhibited NLRP3 priming, NLRP3 inflammasome activation, and pyroptosis in BEAS-2B and RTE cells. Mechanistically, GATA6 was determined to have bound to the promoter region of NLRP3 and synergistically upregulated NLRP3 promoter activity with NF-κB. Furthermore, GATA6 overexpression promoted epithelial-mesenchymal transition via modulating the NF-κB/NLRP3 pathway. Epithelial NLRP3 inflammasome activation triggered ECM production in fibroblasts, which was suppressed by GATA6 knockdown and induced by GATA6 overexpression. Finally, the downregulation of GATA6 alleviated NLRP3 inflammasome-mediated pyroptosis induced by tracheal injury in rats, thereby reducing tracheal stenosis, inflammation, and fibrosis. GATA6 promotes fibrotic repair in tracheal injury through NLRP3 inflammasome-mediated epithelial pyroptosis, making it a potential biological therapeutic target for tracheal injury.
Collapse
Affiliation(s)
- Anmao Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Gu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunyan He
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yishi Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingyu Peng
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaxin Liao
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Xiao
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Xu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuliang Guo
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
7
|
Han C, Kim E, Lee J, Ahn HY. Endotracheal suture through extending tracheostoma for post-tracheostomy tracheal laceration: a case report. J Med Case Rep 2023; 17:208. [PMID: 37161544 PMCID: PMC10170781 DOI: 10.1186/s13256-023-03845-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/26/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Tracheal laceration is very rare but can be life-threatening if proper treatment is not provided. The general concept for the management of tracheal laceration is surgical repair through cervical incision or via thoracotomy. However, in the case of tracheal laceration after tracheostomy, tracheostoma could be extended to avoid urgent surgical repair and additional incision. CASE PRESENTATION A 30-year-old Asian woman suffered intracerebral hemorrhage. Tracheostomy was necessary for prolonged ventilator care. While tracheostomy was performed, the posterior tracheal wall was torn. After observing that, we reinserted endotracheal tube through the oral orifice. Following bronchoscopy showed torn posterior tracheal wall. The tearing wound was 5-6 cm in length, from the middle to distal parts of the trachea. We used minimally invasive procedure for extending the already existing tracheostoma. CONCLUSIONS In the case of tracheal laceration related to tracheostomy, a new incision is not necessary because the tracheal opening already exists. Using the extended tracheostomy technique, tracheal laceration can be repaired by endotracheal suture method.
Collapse
Affiliation(s)
- Changsung Han
- Department of Thoracic and Cardiovascular Surgery and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, 305, Gudeok-Ro, Seo-Gu, Busan, 602-739, Republic of Korea
| | - Eunji Kim
- Department of Thoracic and Cardiovascular Surgery and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, 305, Gudeok-Ro, Seo-Gu, Busan, 602-739, Republic of Korea
| | - Jonggeun Lee
- Department of Thoracic and Cardiovascular Surgery and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, 305, Gudeok-Ro, Seo-Gu, Busan, 602-739, Republic of Korea
| | - Hyo Yeong Ahn
- Department of Thoracic and Cardiovascular Surgery and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, 305, Gudeok-Ro, Seo-Gu, Busan, 602-739, Republic of Korea.
| |
Collapse
|
8
|
Miyawaki M, Ogawa K, Kamada K, Karashima T, Abe M, Takumi Y, Hashimoto T, Osoegawa A, Sugio K. Tracheal injury from dog bite in a child. J Cardiothorac Surg 2023; 18:26. [PMID: 36647124 PMCID: PMC9841626 DOI: 10.1186/s13019-023-02107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Dog bites associated with the head and neck area in children are a common problem. Most of the lacerations are found in the upper lip and the nose region, and tracheal injury is rare [1]. Tracheal injury requires prompt and accurate diagnosis and treatment to rescue the patient. Especially in children, securing the airway is often more difficult than in adults because of their short neck and narrow trachea. In this report, we experienced a pediatric case of multiple dog bites with tracheal injuries in the neck. CASE PRESENTATION We report the case of a 3-year-old girl who presented with multiple dog bites. There were multiple wounds on the head, face, neck, and anterior chest, and air leakage was observed from the cervical wound at the time of transfer. It was difficult to perform oral endotracheal intubation, therefore, we extended the neck wound, probed the trachea with finger, and inserted a tracheal tube directly from the cervical wound in the emergency room. Tracheoplasty and another wound cleansing were performed in the operating room. The patient was discharged on the 18th day after surgery, without further complications. CONCLUSION Tracheal injury from a dog bite is rare. It is important to prompt and accurate diagnosis and treatment. Children should be especially careful because of their short necks and narrow tracheas.
Collapse
Affiliation(s)
- Michiyo Miyawaki
- grid.412334.30000 0001 0665 3553Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita 879-5593 Japan
| | - Kazuya Ogawa
- grid.412334.30000 0001 0665 3553Department of Pediatrics, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita 879-5593 Japan
| | - Kosuke Kamada
- grid.412334.30000 0001 0665 3553Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita 879-5593 Japan
| | - Takashi Karashima
- grid.412334.30000 0001 0665 3553Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita 879-5593 Japan
| | - Miyuki Abe
- grid.412334.30000 0001 0665 3553Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita 879-5593 Japan
| | - Yohei Takumi
- grid.412334.30000 0001 0665 3553Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita 879-5593 Japan
| | - Takafumi Hashimoto
- grid.412334.30000 0001 0665 3553Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita 879-5593 Japan
| | - Atsushi Osoegawa
- grid.412334.30000 0001 0665 3553Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita 879-5593 Japan
| | - Kenji Sugio
- grid.412334.30000 0001 0665 3553Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita 879-5593 Japan
| |
Collapse
|
9
|
Zhou Y, Zhao X, Zhang M, Feng J. Gut microbiota dysbiosis exaggerates ammonia-induced tracheal injury Via TLR4 signaling pathway. Ecotoxicol Environ Saf 2022; 246:114206. [PMID: 36272174 DOI: 10.1016/j.ecoenv.2022.114206] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 05/25/2023]
Abstract
Ammonia is a toxic air pollutant that causes severe respiratory tract injury in animals and humans. Gut microbiota dysbiosis has been found to be involved in the development of respiratory tract injury induced by air pollutants, however, the specific mechanism requires investigation. Here, we found that, inhaled ammonia induced tracheal injury by reducing expression of claudin-1, increasing expression of muc5ac, TLR4, MyD88, NF-κB and cytokines (TNF-α, IL-1β, IL-6 and IL-10), and also altering tracheal microbiota composition. Spearman correlation analysis indicated that gut microbiota dysbiosis positively correlated with TLR4 level in the trachea. Antibiotic depletion intestinal microbiota treatment reduced the severity of ammonia-induced tracheal injury via TLR4 signaling pathway. Microbiota transplantation induced the tracheal injury via TLR4 signaling pathway even without the ammonia exposure. These results indicate that gut microbiota dysbiosis exaggerates ammonia-induced tracheal injury via TLR4 signaling pathway. In addition, the [Ruminococcus]_torques_group, Faecalibacterium, unclassified_f_Lachnospiraceae may be the key gut microbiota contributing to the alterations of tracheal microbiota composition.
Collapse
Affiliation(s)
- Ying Zhou
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing, China.
| | - Xin Zhao
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Minhong Zhang
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing, China.
| | - Jinghai Feng
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing, China
| |
Collapse
|
10
|
Nakamura M, Iizuka S, Nakamura T. Subpleural emphysema as a rare initial manifestation of an iatrogenic tracheal penetration: a case report. Surg Case Rep 2022; 8:203. [PMID: 36273109 PMCID: PMC9588097 DOI: 10.1186/s40792-022-01556-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Background Iatrogenic tracheal injury is a rare but potentially morbid condition and often poses a diagnostic challenge due to its rarity and the lack of specific clinical findings. Because a delayed diagnosis is associated with a higher mortality, a prompt diagnosis is essential. We report a case of an iatrogenic tracheal injury detected by subpleural emphysema as a rare initial manifestation. Case presentation A 75-year-old woman was diagnosed with stage IA2 right lung cancer. During the surgery, visceral subpleural emphysema developed along the lung surface up to the interlobar fissure followed by subcutaneous emphysema in the anterior neck. Suspecting a tracheal injury, we aborted the surgery. Fiberoptic bronchoscopy revealed a longitudinal laceration on the membranous part of the distal trachea without esophageal involvement, consistent with a level II injury. Conservative management was chosen and she had a successful recovery. Conclusions Iatrogenic tracheal injury could initially manifest as visceral subpleural emphysema. Once subpleural emphysema is observed during surgery, a prompt diagnostic workup of the tracheal injury should be performed.
Collapse
Affiliation(s)
- Minori Nakamura
- grid.415466.40000 0004 0377 8408Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-Ku, Hamamatsu-City, Shizuoka 430-8558 Japan
| | - Shuhei Iizuka
- grid.415466.40000 0004 0377 8408Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-Ku, Hamamatsu-City, Shizuoka 430-8558 Japan
| | - Toru Nakamura
- grid.415466.40000 0004 0377 8408Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-Ku, Hamamatsu-City, Shizuoka 430-8558 Japan
| |
Collapse
|
11
|
Takahashi T, Kaneko T, Hane A, Ito A, Kawamoto E, Suzumura M, Ueda K, Shinoda M, Ito A, Imai H. Conservative medical management combined with follow-up multidetector computed tomography of tracheobronchial injury caused by penetrating injuries: A case report. Trauma Case Rep 2022; 42:100710. [PMID: 36247879 PMCID: PMC9561913 DOI: 10.1016/j.tcr.2022.100710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
Tracheobronchial injury (TBI) associated with penetrating injuries has various clinical symptoms and often requires urgent surgical repair. A tracheal tube and/or placement of a drainage tube combined with multidetector computed tomography (CT) could be used to manage TBI without surgical repair in eligible patients. In this case report, we describe an 86-year-old woman with subcutaneous emphysema and suspected TBI caused by three knife wounds in her neck. After tracheal intubation at a local hospital, she was transferred to our hospital. On admission, she was diagnosed with subcutaneous and mediastinal emphysema due to TBI, as well as bilateral pneumothorax. We adjusted the position of the tracheal tube to a distal location from the TBI, and placed bilateral thoracic drainage tubes by referring to the CT images taken on admission and during the follow-up. The follow-up CT images revealed healing of the TBI. She did not show any worsening of her symptoms and she was successfully extubated on day 10 of her hospital stay. On day 18, she was considered self-reliant and was transferred to her previous hospital. Based on our experience in this case, we believe that ventilation with appropriate sedation, placement of a tracheal tube, and drainage are important conservative therapies for TBI caused by penetrating injuries. CT is also useful for evaluating the status of TBI.
Collapse
Affiliation(s)
- Tsuyoshi Takahashi
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan,Corresponding author at: Emergency and Critical Care Center, Mie University Hospital, Tsu, Mie 514-8507, Japan.
| | - Tadashi Kaneko
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Atsuya Hane
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Asami Ito
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Eiji Kawamoto
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Misato Suzumura
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Koki Ueda
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mari Shinoda
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan
| | - Atsushi Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| |
Collapse
|
12
|
Chinthareddy RR, Ashok K, Srikrishna SV, Lingaraju VC. Reverse Macklin effect. Indian J Thorac Cardiovasc Surg 2022; 38:553-555. [PMID: 36050976 PMCID: PMC9424466 DOI: 10.1007/s12055-022-01338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 10/18/2022] Open
Abstract
The Macklin effect is associated with alveolar rupture causing a centripetal spread of air along the peribronchovascular interstitial sheath leading to pneumomediastinum, usually seen in ventilator-related barotrauma or blunt chest trauma. We are presenting a peculiar case of iatrogenic (post-intubational) tracheal injury with massive subcutaneous emphysema and pneumomediastinum, in whom, we suspect that the primary tracheal injury and pneumomediastinum led to dissection of air along the peribronchovascular interstitium, culminating in atelectasis of lung due to compression of the distal-most airways, with no primary parenchymal abnormality. This supposed "reversal" of pathophysiological sequence of the Macklin effect makes it a unique finding.
Collapse
Affiliation(s)
- Rohan Reddy Chinthareddy
- Department of Thoracic Surgery, Mazumdar Shaw Medical Centre, Narayana Health City, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
| | - Karthik Ashok
- Department of Diagnostic Radiology, Mazumdar Shaw Medical Centre, Narayana Health City, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
| | - Srirangapatna Varadaraj Srikrishna
- Department of Thoracic Surgery, Mazumdar Shaw Medical Centre, Narayana Health City, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
| | - Vijay Cholenahalli Lingaraju
- Department of Thoracic Surgery, Mazumdar Shaw Medical Centre, Narayana Health City, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
| |
Collapse
|
13
|
Serio P, Fainardi V, Coletta R, Grasso A, Baggi R, Rufini P, Avenali S, Ricci Z, Morabito A, Trabalzini F. Conservative management of posterior tracheal wall injury by endoscopic stent placement in children: Preliminary data of three cases. Int J Pediatr Otorhinolaryngol 2022; 159:111214. [PMID: 35759914 DOI: 10.1016/j.ijporl.2022.111214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/17/2022] [Accepted: 06/18/2022] [Indexed: 11/26/2022]
Abstract
The management of tracheal wall lacerations is debated. Current treatments are mainly derived by the experience on adults and include conservative or surgical treatments depending on the clinical condition of the patient. We report our preliminary data with removable tracheal stents in 3 children with tracheal tears and respiratory failure. If performed in specialized centers with appropriate endoscopic and clinical follow-up, airway stents can be considered a valid and safe conservative treatment for tracheal tears and an alternative to intubation or tracheostomy. Further studies are needed to compare different therapeutic options and better define the management and duration of stent treatment.
Collapse
Affiliation(s)
- P Serio
- Department of Paediatric Anaesthesia and Intensive Care, Meyer Children Hospital, Florence, Italy.
| | - V Fainardi
- Department of Medicine and Surgery, Cystic Fibrosis Unit, University of Parma, Italy
| | - R Coletta
- Department of Paediatric Surgery, Meyer Children Hospital, University of Florence, Florence, Italy
| | - A Grasso
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - R Baggi
- Respiratory Endoscopy Unit, Meyer Children Hospital, Florence, Italy
| | - P Rufini
- Department of Paediatric Anaesthesia and Intensive Care, Meyer Children Hospital, Florence, Italy
| | - S Avenali
- Respiratory Endoscopy Unit, Meyer Children Hospital, Florence, Italy
| | - Z Ricci
- Department of Paediatric Anaesthesia and Intensive Care, Meyer Children Hospital, Florence, Italy
| | - A Morabito
- Department of Paediatric Surgery, Meyer Children Hospital, University of Florence, Florence, Italy
| | - F Trabalzini
- Department of Otolaryngology, Meyer Children Hospital, Florence, Italy
| |
Collapse
|
14
|
Li KX, Luo YT, Zhou L, Huang JP, Liang P. Tracheal tube misplacement in the thoracic cavity: A case report. World J Clin Cases 2021; 9:10733-10737. [PMID: 35005009 PMCID: PMC8686131 DOI: 10.12998/wjcc.v9.i34.10733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/09/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Penetrating neck injuries require prompt recognition, diagnosis and management of critical airways. This case demonstrates an emergent situation that a “medical negligence” was avoided with the aid of end-tidal carbon dioxide (ETCO2) waveform.
CASE SUMMARY We report a case of malposition of the endotracheal tube into the right hemithoracic cavity for cervical knife trauma, resulting in pneumothorax. Tube placement was not confirmed during emergency airway management, and the patient was directly transferred to the emergency operation room. Assisted by ETCO2 and imaging examinations, the anesthetist timely noticed the absence of ETCO2 waveform and resolved this urgent situation before anesthesia induction.
CONCLUSION This case emphasizes the necessity of ETCO2 waveform and/or X-ray confirmation of endotracheal intubation even in emergent situations.
Collapse
Affiliation(s)
- Ke-Xin Li
- Department of Anesthesiology, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Yu-Ting Luo
- Department of Anesthesiology, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Leng Zhou
- Department of Anesthesiology, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Jia-Peng Huang
- Department of Anesthesiology, University of Louisville, Louisville, KY 40202, United States
| | - Peng Liang
- Day Surgery Center, Department of Anesthesiology, West China Hospital, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
15
|
Xie X, Yu T, Hou Y, Han A, Ding Y, Nie H, Cui Y. Ferulic acid ameliorates lipopolysaccharide-induced tracheal injury via cGMP/PKGII signaling pathway. Respir Res 2021; 22:308. [PMID: 34863181 PMCID: PMC8642995 DOI: 10.1186/s12931-021-01897-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tracheal injury is a common clinical condition that still lacks an effective therapy at present. Stimulation of epithelial sodium channel (ENaC) increases Na+ transport, which is a driving force to keep tracheal mucosa free edema fluid during tracheal injury. Ferulic acid (FA) has been proved to be effective in many respiratory diseases through exerting anti-oxidant, anti-inflammatory, and anti-thrombotic effects. However, these studies rarely involve the level of ion transport, especially ENaC. METHODS C57BL/J male mice were treated intraperitoneally with normal saline or FA (100 mg/kg) 12 h before, and 12 h after intratracheal administration of lipopolysaccharide (LPS, 5 mg/kg), respectively. The effects of FA on tracheal injury were not only assessed through HE staining, immunofluorescence assay, and protein/mRNA expressions of ENaC located on tracheas, but also evaluated by the function of ENaC in mouse tracheal epithelial cells (MTECs). Besides, to explore the detailed mechanism about FA involved in LPS-induced tracheal injury, the content of cyclic guanosine monophosphate (cGMP) was measured, and Rp-cGMP (cGMP inhibitor) or cGMP-dependent protein kinase II (PKGII)-siRNA (siPKGII) were applied in primary MTECs, respectively. RESULTS Histological examination results demonstrated that tracheal injury was obviously attenuated by pretreatment of FA. Meanwhile, FA could reverse LPS-induced reduction of both protein/mRNA expressions and ENaC activity. ELISA assay verified cGMP content was increased by FA, and administration of Rp-cGMP or transfection of siPKGII could reverse the FA up-regulated ENaC protein expression in MTECs. CONCLUSIONS Ferulic acid can attenuate LPS-induced tracheal injury through up-regulation of ENaC at least partially via the cGMP/PKGII pathway, which may provide a promising new direction for preventive and therapeutic strategy in tracheal injury.
Collapse
Affiliation(s)
- Xiaoyong Xie
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China.,Department of Stem Cells and Regenerative Medicine, College of Basic Medical Science, China Medical University, Shenyang, 110122, China
| | - Tong Yu
- Department of Stem Cells and Regenerative Medicine, College of Basic Medical Science, China Medical University, Shenyang, 110122, China
| | - Yapeng Hou
- Department of Stem Cells and Regenerative Medicine, College of Basic Medical Science, China Medical University, Shenyang, 110122, China
| | - Aixin Han
- Department of Stem Cells and Regenerative Medicine, College of Basic Medical Science, China Medical University, Shenyang, 110122, China
| | - Yan Ding
- Department of Stem Cells and Regenerative Medicine, College of Basic Medical Science, China Medical University, Shenyang, 110122, China
| | - Hongguang Nie
- Department of Stem Cells and Regenerative Medicine, College of Basic Medical Science, China Medical University, Shenyang, 110122, China.
| | - Yong Cui
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, 110001, China.
| |
Collapse
|
16
|
Cathelain G, Perrier A, Folliot L, Le Gloanec C, Rarrbo M, Jouen F, Saudeau E, Costa G, Carlier R, Bergounioux J. Bench testing of tracheostomy tube-related insults using an instrumented manikin. Eur Arch Otorhinolaryngol 2021; 279:1593-1599. [PMID: 34499203 DOI: 10.1007/s00405-021-07054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Choosing the right tracheal tube for the right patient is a daily preoccupation for intensivists and emergency physicians. Tracheal tubes can generate severe complications, which are chiefly due to the pressures applied by the tube to the trachea. We designed a bench study to assess the frequency of pressure levels likely to cause tracheal injury. METHODS We tested the pressure applied on the trachea by 17 tube models of a given size range. To this end, we added a pressure sensor to the posterior tracheal wall of a standardized manikin. RESULTS Only 2 of the 17 tubes generated pressures under the threshold likely to induce tracheal injury (30 mmHg/3.99 kPa). The force exerted on the posterior wall of the trachea varied widely across tube models. CONCLUSION Most models of tracheal tubes resulted in forces applied to the trachea that are usually considered capable of causing tracheal tissue injury. LEVEL OF EVIDENCE Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence: How common is the problem?: step 1; Is this diagnostic or monitoring test accurate? (Diagnosis) step 5; What will happen if we do not add a therapy? (Prognosis) n/a; Does this intervention help? (Treatment Benefits) step 5; What are the COMMON harms?(Treatment Harms) step 5; What are the RARE harms? (Treatment Harms) step 5; Is this (early detection) test worthwhile? (Screening) step 5.
Collapse
Affiliation(s)
- Guillaume Cathelain
- CHArt Laboratory, Ecole Pratique Des Hautes Etudes, PSL University, Paris, France
| | - Antoine Perrier
- Université Grenoble Alpes and CNRS, TIMC-IMAG, 38000, Grenoble, France.,Pitié-Salpêtrière Teaching Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Ludivine Folliot
- DMU Smart Imaging, Radiology Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France
| | - Cyrielle Le Gloanec
- Clinical Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France
| | - Mohamed Rarrbo
- Clinical Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France
| | - François Jouen
- CHArt Laboratory, Ecole Pratique Des Hautes Etudes, PSL University, Paris, France
| | - Etienne Saudeau
- Pediatric Intensive Care Unit, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France.,UMR 1179 End-iCap, UVSQ, Paris-Saclay, Versailles, France
| | - Guillaume Costa
- Pediatric Intensive Care Unit, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France.,UMR 1179 End-iCap, UVSQ, Paris-Saclay, Versailles, France
| | - Robert Carlier
- DMU Smart Imaging, Radiology Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France.,UMR 1179 End-iCap, UVSQ, Paris-Saclay, Versailles, France
| | - Jean Bergounioux
- Pediatric Intensive Care Unit, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France. .,Simone Veil Health Science Centre, Université Versailles SQY, Paris-Saclay, Versailles, France. .,Réanimation et Soins Intensifs Pédiatriques, Batiment Letulle, 3ème étage, Hôpital Universitaire Raymond Poincaré, APHP, 104 Boulevard Raymond Poincaré, Garches, 92380, Paris, France.
| |
Collapse
|
17
|
Marano A, Palagi S, Pellegrino L, Borghi F. Robotic Intraoperative Tracheobronchial Repair during Minimally Invasive 3-Stage Esophagectomy. J Chest Surg 2021; 54:154-157. [PMID: 33115977 PMCID: PMC8038889 DOI: 10.5090/jcs.20.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/04/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
Tracheobronchial injury (TBI) is an uncommon but potentially fatal event. Iatrogenic lesions during bronchoscopy, endotracheal intubation, or thoracic surgery are considered the most common causes of TBI. When TBI is detected during surgery, concomitant surgical treatment is recommended. Herein we present a case of successful robotic primary repair of iatrogenic tracheal and left bronchial branch tears during a robot-assisted hybrid 3-stage esophagectomy after neoadjuvant chemoradiotherapy. A robotic approach can facilitate the repair of this injury while reducing both the potential risk of conversion to open surgery and the associated increased risk of postoperative respiratory complications.
Collapse
Affiliation(s)
- Alessandra Marano
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Silvia Palagi
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Luca Pellegrino
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Felice Borghi
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| |
Collapse
|
18
|
Frost A, Ruszkay N, Steinberg TB, Atkins J, Mirza N. Iatrogenic Tracheal Injuries: Case Series and Review of the Literature. ORL J Otorhinolaryngol Relat Spec 2020; 83:123-126. [PMID: 33296903 DOI: 10.1159/000511712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022]
Abstract
Iatrogenic tracheal injuries are an uncommon but serious complication of endotracheal tube intubation. We present two cases that illustrate iatrogenic tracheal injuries presenting hours after the time of their injury. This report addresses the critical diagnostic evaluation and management of iatrogenic tracheal injuries resulting from endotracheal intubation.
Collapse
Affiliation(s)
- Ariel Frost
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
| | - Nicole Ruszkay
- Department of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Toby B Steinberg
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua Atkins
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Natasha Mirza
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
19
|
Voelker J, Voelker C, Engert J, Schendzielorz P, Hagen R, Rak K. Severe tracheobronchial harm due to lithium button battery aspiration: An in vitro study of the pathomechanism and injury pattern. Int J Pediatr Otorhinolaryngol 2020; 139:110431. [PMID: 33053459 DOI: 10.1016/j.ijporl.2020.110431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Button battery incidents have become a rising medical issue in recent years, especially for infants. The increasing number of these cases can be explained by the expanding use of objects of everyday life and toys. As a result, button batteries in many households are ubiquitous in different states of charge. The extremely long shelf-life and the increasing energy densities of lithium button batteries boost the potential medical complications of accidental swallowing. OBJECTIVE The study aimed to analyze the pathophysiology of damage to tracheobronchial structures by button batteries aspiration over time. METHODS CR2032 and CR927 lithium button batteries (3.2/3.0 V) were exposed to porcine trachea preparations intraluminal at 37 °C in intervals up to 36 h. Measurements were made of the voltage curve, the discharge current, and the resulting pH values around the electrodes. The effects on tissue were examined using macroscopic time-lapse images and microscopic pictures of sections of the fixed specimens over time. FINDINGS The examinations showed a tissue electrolysis reaction directly after the beginning of battery exposure, which led to an immediate coagulation impairment of the respiratory epithelium. Over time, a strongly alkaline environment was established around the batteries. The resulting tissue colliquation caused profound tissue damage beyond the basal membrane of the mucosa, affecting the tracheobronchial cartilage after only 4 h of exposure time. After 12 h, there was significant necrosis of the annular ligaments of the trachea and the peribronchial pulmonary tissue. After completion of the experimental exposure time of 36 h, there was still a sufficient residual voltage on all button batteries of the experiments. CONCLUSIONS Besides accidental ingestion, the aspiration of button batteries is a life-threatening situation. The partial or complete acute airway obstruction in the trachea or the bronchi initially is the leading symptom, as with any foreign body aspiration. However, the results of the investigations show that even after a short exposure time, relevant tissue damage can be caused by the electrolysis reaction of the battery. After 12 h, a profound destruction of cartilage, connective tissue, and smooth muscles was observed in vitro, which may cause significant consequential damage in vivo. These findings reveal the need for rapid diagnosis and immediate foreign body removal after any battery ingestion. Moreover, the results show how relevant prevention of these accidents is, and that future safety modifications of these types of battery by the manufacturers would be appropriate.
Collapse
Affiliation(s)
- Johannes Voelker
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany.
| | - Christine Voelker
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany
| | - Jonas Engert
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany
| | - Philipp Schendzielorz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany
| | - Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wuerzburg, Germany
| |
Collapse
|
20
|
Pandey V, Panigrahi P, Kumar R, Upadhyayay AD, Sharma SP. Novel approach for the dissection of upper pouch during primary repair of esophageal atresia with tracheoesophageal fistula: Technique and results. J Pediatr Surg 2020; 55:767-771. [PMID: 31706617 DOI: 10.1016/j.jpedsurg.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND We describe a technical modification to approach for dissection of proximal pouch in patients undergoing the primary repair of congenital Esophageal atresia with tracheoesophageal fistula (EA-TEF). METHODS A prospective comparative study was performed from January 2016 to December, 2019 including the patients who were undergoing primary repair of EA-TEF (Type C). The patients were divided into Group A (upper pouch dissection by classical approach) and Group B (technical modification). The two groups were compared for operative outcome and complications. Modified OSATS score was used to rate the performance of operators in two groups and were compared. RESULTS Total of 70 patients were included. In Group B, the mean operating time was less compared to Group A. The incidence of tracheal injury was also less when compared to previous data (p = 0.042). Mean OSATS score for flow of operation and overall performance was better in Group B (p = 0.002, p = 0.005). The OSATS score was also better for fifth and seventh case in Group B, proving its faster learning by trainee fellows. CONCLUSION The technical modification decreases chances of tracheal injury and shortens the learning curve for upper pouch dissection. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Vaibhav Pandey
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P..
| | - Pranay Panigrahi
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P
| | - Rakesh Kumar
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P
| | - Arj Deo Upadhyayay
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P
| | - Shiv P Sharma
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P
| |
Collapse
|
21
|
Husain R, Alnasser A, Al Duhileb M, Madkhali T. First tracheal ring fracture in a complex thyroid surgery. Int J Surg Case Rep 2020; 66:309-312. [PMID: 31901739 PMCID: PMC6948263 DOI: 10.1016/j.ijscr.2019.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/27/2019] [Accepted: 12/10/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Tracheal injury is a rare complication of thyroidectomy that endocrine surgeons might face during or after the surgery. It accounts for less than 1 % of all thyroidectomy complications. CASE PRESENTATION A 48-year-old who presented with hyperthyroidism signs and symptoms, diagnosed with Graves' disease. Patient underwent total thyroidectomy after failure of the medical management that ended in first tracheal ring laceration. Tracheal laceration discovered intraoperatively and repaired with primary closure. DISCUSSION Tracheal injury is one of the rare complications of thyroidectomy. It can be discovered intraoperative or postoperative. Tracheal injury can be managed conservatively or surgically depending on the size of the injury. But, the early diagnosis of it can lead to better outcome and decrease the mortality and morbidity. CONCLUSION Tracheal injury can be prevented by increasing the awareness of its presentation and its risk factors.
Collapse
Affiliation(s)
- Raja Husain
- King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Asayil Alnasser
- King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Tariq Madkhali
- Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| |
Collapse
|
22
|
Abstract
INTRODUCTION Airway injury is a very rare complication of thyroglossal duct cyst surgery in children. The wound is most frequently located at the larynx, due to a confusion between the hyoid bone and the thyroid cartilage. OBSERVATION This is the first report of a tracheal injury complicating Sistrunk's procedure in a 3 year old child, revealed by respiratory distress. Conservative treatment was suggested, requiring a tracheostomy lasting 49 days, leading to decanulation and complete anatomical and functional recovery. CONCLUSION This report highlights the specificity of pediatric laryngotracheal anatomy.
Collapse
Affiliation(s)
- F Blanc
- Service d'ORL et chirurgie cervico-faciale, UAM d'ORL pédiatrique, Hôpital Gui-de-Chauliac, Université de Montpellier, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
| | - C Blanchet
- Service d'ORL et chirurgie cervico-faciale, UAM d'ORL pédiatrique, Hôpital Gui-de-Chauliac, Université de Montpellier, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - M Mondain
- Service d'ORL et chirurgie cervico-faciale, UAM d'ORL pédiatrique, Hôpital Gui-de-Chauliac, Université de Montpellier, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - M Akkari
- Service d'ORL et chirurgie cervico-faciale, UAM d'ORL pédiatrique, Hôpital Gui-de-Chauliac, Université de Montpellier, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| |
Collapse
|
23
|
Abstract
This article reviews the presentation, diagnosis, and management of common traumatic injuries of the ear, nose, and throat, including laryngeal trauma, auricular and septal hematomas, and tympanic membrane rupture.
Collapse
Affiliation(s)
- Mac Henry
- Alameda Health System, Highland Hospital, 1411 East 31st, Oakland, CA 94602, USA
| | - H Gene Hern
- Emergency Medicine, Alameda Health System, Highland Hospital, 1411 East 31st, Oakland, CA 94602, USA.
| |
Collapse
|
24
|
Jung YC, Sung K, Cho JH. Iatrogenic Tracheal Posterior Wall Perforation Repaired with Bronchoscope-Guided Knotless Sutures Through Tracheostomy. Korean J Thorac Cardiovasc Surg 2018; 51:277-279. [PMID: 30109207 PMCID: PMC6089622 DOI: 10.5090/kjtcs.2018.51.4.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/16/2022]
Abstract
A 68-year-old man presented with a posterior tracheal wall injury caused by percutaneous dilatational tracheostomy. The wound was immediately covered with an absorbable polyglycolic acid sheet. Ten days after the injury, the perforation was closed with knotless sutures using a Castroviejo needle-holder through the tracheostomy. The successful repair in this case indicates the feasibility of the knotless suture technique for perforations. The technique is described in detail in this report. The patient was weaned from the mechanical ventilator on postoperative day 25. In cases of posterior tracheal posterior wall perforation, every effort should be made to repair the perforation through an existing opening.
Collapse
Affiliation(s)
- Yong Chae Jung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| |
Collapse
|
25
|
Hong SB, Lee JY, Lee J, Choi KB, Suh JH. Right Main Bronchus Rupture Presenting with Pneumoperitoneum. Korean J Thorac Cardiovasc Surg 2018; 51:216-219. [PMID: 29854669 PMCID: PMC5973221 DOI: 10.5090/kjtcs.2018.51.3.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 01/10/2023]
Abstract
We report the case of a 16-year-old male patient who was involved in a traffic accident and transferred to the emergency department with mild chest pain. We initially did not find evidence of tracheal injury on computed tomography (CT). Within an hour after presentation, the patient developed severe dyspnea and newly developed subcutaneous emphysema and pneumoperitoneum were discovered. Abdominal CT showed no intra-abdominal injury. However, destruction of the right main bronchus was identified on coronal images of the initially performed CT scan. Emergency exploratory surgery was performed. The amputated right main bronchus was identified. End-to-end tracheobronchial anastomosis was performed, and the patient recovered without any complications.
Collapse
Affiliation(s)
- Seok Beom Hong
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Ji Yoon Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - June Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Kuk Bin Choi
- The 8th Mechanized Infantry Division, The 3rd Republic of Korea Army
| | - Jong Hui Suh
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| |
Collapse
|
26
|
Pisano A, Verniero L, Galdieri N, Corcione A. Assessing the correct inflation of the endotracheal tube cuff: a larger pilot balloon increases the sensitivity of the 'finger-pressure' technique, but it remains poorly reliable in clinical practice. J Clin Monit Comput 2019; 33:301-5. [PMID: 29789999 DOI: 10.1007/s10877-018-0158-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/20/2018] [Indexed: 10/16/2022]
Abstract
The pilot balloon palpation (or 'finger-pressure') method is still widely used to assess the endotracheal tube cuff inflation, despite consistent evidence of its poor sensitivity in recognizing cuff overinflation. It was recently speculated that this may be related to the lower wall tension (due to the smaller radius) of the pilot balloon as compared with the cuff, according to Laplace's law. To verify this hypothesis and, secondarily, to assess whether the use of a 'large' pilot balloon (identical to the cuff) increases the reliability of this technique, 62 anesthetists (41 experienced anesthesiologists and 21 residents) were asked to estimate the pressure of a cuff inflated to 88 mmHg into a simulated trachea by feeling both a usual and a modified 'large' pilot balloon. A similar test was repeated at 40 mmHg. After palpation of the usual pilot balloon, only 35% of participants (49% of experienced anesthesiologists and 10% of residents) recognized considerable overinflation (88 mmHg), as compared with 87% of participants (95% of experienced anesthesiologists and 71% of residents) after palpation of the 'large' pilot balloon. Moreover, 89% of participants (85% of experienced anesthesiologists and 95% of residents) believed that pressure was higher in the 'large' balloon than in the normal one. However, only 32% of participants (51% of experienced anesthesiologists and none of residents) recognized slight overinflation (40 mmHg) after feeling the 'large' balloon. The pilot balloon size affects the sensitivity of the 'finger-pressure' technique, but it remains poorly reliable with a larger pilot balloon.
Collapse
|
27
|
Tartaglia N, Iadarola R, Di Lascia A, Cianci P, Fersini A, Ambrosi A. What is the treatment of tracheal lesions associated with traditional thyroidectomy? Case report and systematic review. World J Emerg Surg 2018; 13:15. [PMID: 29588652 PMCID: PMC5865337 DOI: 10.1186/s13017-018-0175-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/06/2018] [Indexed: 02/08/2023] Open
Abstract
Aim The aim of this study is to review the literature focusing on various treatments based on time of tracheal injury and on different surgeons' personal experience. Methods We retrospectively reviewed all cases of total thyroidectomy performed at the University Surgical Department of Ospedali Riuniti of Foggia from 2006 to 2017. Only a single case of tracheal lesion due to traditional total thyroidectomy was found. An extensive search of the relevant literature was carried out using MEDLINE (PubMed). We included articles that reported article type, patient number, sex, age, reasons for surgery, time of tracheal perforation intraoperatively or delayed rupture, symptoms, diagnosis, type of surgical procedure, pathological report and follow-up. Results A total of 156 published studies were screened from the sources listed. Of these, 15 studies were included in the present study. We introduced our case in the analysis. A total of 16 patients were totally analysed. There were seven males (43.7%) and seven females (43.7%), and for two patients, gender was not available. The mean patient age was 41.6 years. Conclusions The literature review showed very few cases treated differently. However, it would be good to standardise treatments. Tracheal perforation, if encountered, needs to be managed appropriately in centres of expertise with a high volume of thyroidectomies.
Collapse
Affiliation(s)
- Nicola Tartaglia
- Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
| | - Roberta Iadarola
- Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
| | - Alessandra Di Lascia
- Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
| | - Pasquale Cianci
- Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
| | - Alberto Fersini
- Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
| | - Antonio Ambrosi
- Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
| |
Collapse
|
28
|
Eichler L, Simon M, Kluge S. [Tracheal laceration after dilatational tracheostomy : A case of succesful conservative management]. Med Klin Intensivmed Notfmed 2017; 112:629-31. [PMID: 28078354 DOI: 10.1007/s00063-016-0255-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/29/2016] [Accepted: 12/05/2016] [Indexed: 10/25/2022]
Abstract
During bronchoscopically guided percutaneous dilatational tracheostomy, a 71-year-old woman suffered a long-stretched tear to the posterior tracheal wall. The injury was suspected to be caused by blunt trauma during dilation or cannula insertion, possibly aggravated by vigorous cuff inflation. Since the defect ended just 0.5 cm proximal to the main carina, placing a cuffed endotracheal tube beyond the injury was not an option. However, we decided for a conservative treatment approach by placing a cuffed endotracheal tube under bronchoscopic visualization in direct proximity to the cranial end of the laceration. The further course of the patient was uneventful and complete healing was documented by bronchoscopic inspection on a regular basis.
Collapse
|
29
|
Abstract
Tracheal and bronchial injury, including iatrogenic injury and traumatic injury, the former usually occurred in the operation, intubation or bronchoscopy. The latter was occurred in a variety of blunt trauma, often combined with a variety of complex injuries. The therapeutic approach can be differentiated, surgical or conservative, no criteria has been universally accepted. Successful treatment of tracheobronchial injuries requires early diagnostic evaluation. This article aims to review the indications and therapeutic options for tracheal and bronchial injuries.
Collapse
Affiliation(s)
- Zhengwei Zhao
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Tianyi Zhang
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Xunliang Yin
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Jinbo Zhao
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Yongan Zhou
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| |
Collapse
|
30
|
Singh P, Wojnar M, Malhotra A. Iatrogenic tracheal laceration in the setting of chronic steroids. J Clin Anesth 2016; 37:38-42. [PMID: 28235525 DOI: 10.1016/j.jclinane.2016.10.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 10/01/2016] [Accepted: 10/28/2016] [Indexed: 02/06/2023]
Abstract
We report the case of a 71-year-old woman with end-stage chronic obstructive pulmonary disease who presented with a 10-cm tracheal laceration from a presumed traumatic intubation in the setting of respiratory distress and chronic obstructive pulmonary disease exacerbation and subsequently developed significant subcutaneous emphysema along her neck and mediastinum in addition to her peritoneum and mesentery. We were successfully able to treat this patient conservatively up until the time that tracheostomy was warranted. We discuss and review tracheobronchial injuries with respect to etiology, risk factors, and management and hope to benefit health care providers managing airways in patients at risk for tracheal injury.
Collapse
Affiliation(s)
- Punit Singh
- Department of Anesthesiology, Penn State College of Medicine, Penn State Hershey, Medical Center, Hershey, PA 17033, USA.
| | - Margaret Wojnar
- Department of Critical Care Medicine, Penn State College of Medicine, Penn State, Hershey Medical Center, Hershey, PA 17033, USA
| | - Anita Malhotra
- Department of Anesthesiology, Penn State College of Medicine, Penn State Hershey, Medical Center, Hershey, PA 17033, USA
| |
Collapse
|
31
|
Feng TR, Ye Y, Doyle DJ. Critical importance of tracheal tube cuff pressure management. World J Anesthesiol 2015; 4:10-12. [DOI: 10.5313/wja.v4.i2.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/27/2015] [Accepted: 05/28/2015] [Indexed: 02/06/2023] Open
Abstract
The ideal range for tracheal tube cuff pressures is usually taken to be between 20 to 30 cm H2O. This is easily measured with a cuff pressure manometer and should be measured in each instance. The importance of tracheal tube cuff pressures is highlighted by the spectrum of airway complications that can occur with incorrect cuff pressures. High cuff pressures can result in complications ranging from sore throat and hoarseness to tracheal stenosis, necrosis, and even rupture. In such cases, the postulated causative factor is diminished blood flow to tracheal mucosa due to excessive cuff pressure on the tracheal wall. This hypothesized ischemic injury then produces healing fibrosis months or even years later. On the other hand, cuff pressures that are too low place the patient at risk for aspiration of gastric contents and consequently, aspiration pneumonitis and pneumonia. This is why the authors recommend that cuff pressures be measured following all intubations.
Collapse
|
32
|
Bouattour K, Prost-Lapeyre A, Hauw-Berlemont C, Diehl JL, Guérot E. [A post-intubation tracheal rupture in intensive care unit]. ACTA ACUST UNITED AC 2014; 33:590-2. [PMID: 25450732 DOI: 10.1016/j.annfar.2014.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/08/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Tracheal rupture is one of the most serious post-intubation complication. However, it is widely underestimated. CLINICAL CASE An 86-year-old patient with a history of pancreas adenocarcinoma treated with gemcitabin was admitted in intensive care unit for an acute respiratory failure with no identified etiology. The worsening of her respiratory status required invasive mechanical ventilation. One laryngoscopy, performed by a trained operator, found a Cormack 1. Intubation was realized without stylet and the cuff inflated with a syringe. Hemodynamic instability, impaired gas exchange and an extensive subcutaneous emphysema occurred immediately. A CT-scan showed a supracarinal tracheal rupture. COMMENT The etiological analysis of this case identifies several causes of pars membranosa fragility, such as female sex, age greater than 50 years and the short stature. The emergency intubation and the cuff inflated by a syringe were the risk factors of tracheal rupture in this patient. CONCLUSION Special care should be paid to this complication, early diagnosis has probably a prognostic value. Training operators in the use of stylets and monitoring cuff pressure are required.
Collapse
Affiliation(s)
- K Bouattour
- Service de réanimation médicale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France
| | - A Prost-Lapeyre
- Service de réanimation médicale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France
| | - C Hauw-Berlemont
- Service de réanimation médicale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France
| | - J-L Diehl
- Service de réanimation médicale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France
| | - E Guérot
- Service de réanimation médicale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France.
| |
Collapse
|
33
|
Huh H, Han JH, Chung JY, Yi JW, Lee BJ, Kim DO, Kim KS. Anesthetic management of penetrating neck injury patient with embedded knife -A case report-. Korean J Anesthesiol 2012; 62:172-4. [PMID: 22379574 PMCID: PMC3284741 DOI: 10.4097/kjae.2012.62.2.172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 06/26/2011] [Accepted: 07/04/2011] [Indexed: 12/17/2022] Open
Abstract
Penetrating neck injuries can be a fatal event and they are difficult to manage for both surgeons and anesthesiologists. So, adequate preoperative evaluation is important to improve the patients' outcomes, but this can not be done for hemodynamically unstable or uncooperative patient. Here we present our clinical experience with a patient with a penetrating neck injury and who was hemodynamically stable, but she was uncooperative and the knife was still embedded in her neck. The surgical exploration and bronchoscopic examination were successfully done under monitored anesthesia care.
Collapse
Affiliation(s)
- Hyub Huh
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|