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Ovári A, Just T, Dommerich S, Hingst V, Böttcher A, Schuldt T, Guder E, Mencke T, Pau HW. Conservative management of post-intubation tracheal tears-report of three cases. J Thorac Dis 2014; 6:E85-91. [PMID: 24977034 DOI: 10.3978/j.issn.2072-1439.2014.03.30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/05/2014] [Indexed: 12/11/2022]
Abstract
Iatrogenic tracheal rupture is a rare complication after intubation. We present three patients with tracheal tears. In all of these patients, a common finding was a lesion of the posterior tracheal wall with postoperative subcutaneous and emphysema as the first clinical sign of the rupture. Diagnosis and follow-up were based on clinical and endoscopic findings and chest computed tomography (CT) scans. In our cases with progressive subcutaneous and mediastinal emphysema or dyspnea, we performed a tracheotomy and bypassed the lesion with a tracheostomy tube to avoid an increase in air leakage into the mediastinum. Under broad-spectrum antibiotic therapy, no mediastinitis occurred and all patients survived without sequelae. Closure of tracheostomy was scheduled for 1-2 months after tracheal injury. Analysis of surgical and anesthesiological procedures revealed no abnormalities and the accumulation of tracheal injuries was considered as accidental. We found that in clinically stable patients with spontaneous breathing and with no mediastinitis, a conservative management of tracheal tears is a safe procedure.
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Affiliation(s)
- Attila Ovári
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Tino Just
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Steffen Dommerich
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Volker Hingst
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Arne Böttcher
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Tobias Schuldt
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Ellen Guder
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Thomas Mencke
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Hans-Wilhelm Pau
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
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