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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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2
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Park JV, Williams AM, Scott JW, Blank R, Reddy RM. Management of a traumatic avulsion of the right upper lobe bronchus. Trauma Case Rep 2022; 40:100660. [PMID: 35665195 PMCID: PMC9156978 DOI: 10.1016/j.tcr.2022.100660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/26/2022] Open
Abstract
Tracheobronchial injuries are rare but life-threatening and require early diagnosis, appropriate airway management, and emergent surgical intervention. We report a case of a post-traumatic, isolated avulsion of the right upper lobe bronchus in a 60-year-old woman involved in a pedestrian versus motor vehicle accident. After transfer from an outside hospital with a single lumen endotracheal tube and multiple right sided chest tubes with large air leaks, the patient was taken to the OR for bronchoscopy and surgical exploration. Intraoperatively, a complete avulsion of the right upper lobe was noted. Due to the extended time period from original injury and excellent reported functional status, our patient underwent completion lobectomy of the right upper lobe, primary bronchial repair, with an azygous vein flap.
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3
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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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4
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Riduan AN, Sathiamurthy N, Dharmaraj B, Chai DN, Balasubbiah N. Repairing the injured bronchus in blunt chest trauma – A case series. TRAUMA-ENGLAND 2022. [DOI: 10.1177/1460408620988116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Traumatic bronchial injury (TBI) is uncommon, difficult to diagnose and often missed. The incidence of TBI among blunt trauma patients is estimated to be around 0.5–2%. Bronchoplastic surgery is indicated in most cases to repair the tracheobronchial airway and preserve lung capacity. There is limited existing literature addressing the management of this condition in view of its rarity. The comprehensive management and outcomes of these patients are discussed. Methods The case notes of all patients who presented with persistent lung collapse due to trauma since July 2017 were reviewed retrospectively. Those patients requiring surgical intervention were included in the review. The mode of injury, clinical, radiological and bronchoscopy findings, concurrent injuries, type of surgery, length of stay (LOS) and operative outcomes were reviewed. Results Out of 11 patients who presented with persistent lung collapse post-blunt trauma, four (36%) were found to have structural bronchial disruption. All of them underwent successful repair of the injured bronchus, without the need of a pneumonectomy. The other seven patients were successfully treated conservatively. Conclusion The repair of the injured bronchus is essential in improving respiratory function and to prevent a pneumonectomy. Routine bronchoscopic evaluation should be performed for all suspected airway injuries as recommended in our management algorithm. Delayed presentations should not hinder urgent referral to thoracic centers for tracheobronchial reconstruction.
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Affiliation(s)
| | | | | | - Diong Nguk Chai
- Thoracic Unit, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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5
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Hamada S, Ohsumi A, Goto T, Hamaji M, Date H, Hirai T. Delayed Right Main Bronchus Stenosis With Involvement of the Tracheal Carina After Blunt Chest Trauma: Successful Treatment With Tracheobronchial Anastomosis. Arch Bronconeumol 2021; 57:551-552. [PMID: 35699038 DOI: 10.1016/j.arbr.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/08/2020] [Indexed: 06/15/2023]
Affiliation(s)
- Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Respiratory Medicine, Ayabe City Hospital, Kyoto, Japan.
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Goto
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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6
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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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7
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Abstract
Tracheobronchial injuries (TBI) are a heterogenous group of sometimes life-threatening traumas with different management approaches. Symptoms are mediastinal and subcutaneous emphysema, bloody secretions from the airway or haemoptysis in alert patients, and high air leakage along the cuff or increased ventilatory resistance may be signs for TBI in intubated patients. The necessity of immediate clinical evaluation, CT-scan and bronchoscopic evaluation are essential for prompt diagnosis and classification as well as experienced air way management and treatment, these patients are best managed from interdisciplinary teams including thoracic surgeons. While iatrogenic tracheal membrane laceration from intubation can be treated by lesion bridging with ventilation tube, stent application, open operative repair or endoluminal repair, intraoperative accidental cuts should be repaired by direct suture or with vital tissue coverage in case of local ischemia. The management of blunt or penetrating injury is sequential and needs immediate establishment and maintenance of a secure patent airway to provide adequate oxygenation. The next step is the treatment of life-threatening collateral injuries like major hemorrhage, cranial trauma or major organ damage arranged in the trauma team. The treatment of penetrating injuries to the airway need operative exploration in almost every case with minimal local dissection and debridement followed by direct repair. Muscle flap coverage is useful in case of combined esophageal injury. Damage of the tracheobronchial tree after blunt trauma must be repaired by direct suture or local tissue sparing resection and anastomosis. These lesions can be missed in the initial phase and may become prominent with scar tissue formation, stenosis and atelectasis in the later phases.
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Affiliation(s)
- Stefan Welter
- Department of thoracic surgery, Lung Clinic Hemer, Hemer, Germany
| | - Weam Essaleh
- Department of thoracic surgery, Lung Clinic Hemer, Hemer, Germany
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8
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Hamada S, Ohsumi A, Goto T, Hamaji M, Date H, Hirai T. Delayed Right Main Bronchus Stenosis With Involvement of the Tracheal Carina After Blunt Chest Trauma: Successful Treatment With Tracheobronchial Anastomosis. Arch Bronconeumol 2020; 57:S0300-2896(20)30341-0. [PMID: 33127198 DOI: 10.1016/j.arbres.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/13/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Respiratory Medicine, Ayabe City Hospital, Kyoto, Japan.
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Goto
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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9
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Abdelmohty H, Elanwar MA, Abdelgawad BM. Urgent surgical repair is pivotal in the management of major airway injury due to blunt trauma. THE CARDIOTHORACIC SURGEON 2020. [DOI: 10.1186/s43057-020-00031-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
Background
Blunt traumatic airway injury is a life-threatening injury in which urgent management is pivotal and this would come through improving our clinical management and diagnostic tools. Our objective was to emphasize the importance of early referral and urgent surgical repair of major airway injury.
Results
Records of 42 patients with major airway injury out of 17,520 registered thoracic trauma cases were reviewed over the past 15 years. Twenty-eight cases documented to have major tracheobronchial injuries due to blunt trauma underwent surgical repair either urgent (21 cases) or late (7 cases). The age ranged from 8 to 43 years old with a mean age of 22.3 ± 0.8. The most common presenting symptom was shortness of breath in 22 (78.6%) cases and the most frequent sign was subcutaneous emphysema which was seen in 22 (78.6%) cases. The postoperative morbidity and mortality rates were significantly higher in the delayed repair group (p value < 0.001).
Conclusion
The urgent surgical repair is the treatment of choice for major airway injury which is facilitated by early recognition and referral. It is pivotal to avoid respiratory and systemic complications and related mortality.
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10
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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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11
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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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12
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Zong ZW, Wang ZN, Chen SX, Qin H, Zhang LY, Shen Y, Yang L, Du WQ, Chen C, Zhong X, Zhang L, Huo JT, Kuai LP, Shu LX, Du GF, Zhao YF. Chinese expert consensus on echelons treatment of thoracic injury in modern warfare. Mil Med Res 2018; 5:34. [PMID: 30286811 PMCID: PMC6171144 DOI: 10.1186/s40779-018-0181-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/13/2018] [Indexed: 02/07/2023] Open
Abstract
The emergency treatment of thoracic injuries varies of general conditions and modern warfare. However, there are no unified battlefield treatment guidelines for thoracic injuries in the Chinese People's Liberation Army (PLA). An expert consensus has been reached based on the epidemiology of thoracic injuries and the concept of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since there are no differences in the specialized treatment for thoracic injuries between general conditions and modern warfare, first aid, emergency treatment, and early treatment of thoracic injuries are introduced separately in three levels in this consensus. At Level I facilities, tension pneumothorax and open pneumothorax are recommended for initial assessment during the first aid stage. Re-evaluation and further treatment for hemothorax, flail chest, and pericardial tamponade are recommended at Level II facilities. At Level III facilities, simple surgical operations such as emergency thoracotomy and debridement surgery for open pneumothorax are recommended. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.
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Affiliation(s)
- Zhao-Wen Zong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400038, China.
| | - Zhi-Nong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Si-Xu Chen
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400038, China
| | - Hao Qin
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400038, China
| | - Lian-Yang Zhang
- Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Yue Shen
- Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Lei Yang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400038, China
| | - Wen-Qiong Du
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400038, China
| | - Can Chen
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400038, China
| | - Xin Zhong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400038, China
| | - Lin Zhang
- Special Clinic Department of Bethune Medical Profession Sergeant School, Shijiazhuang, 050000, China
| | - Jiang-Tao Huo
- Special Clinic Department of Bethune Medical Profession Sergeant School, Shijiazhuang, 050000, China
| | - Li-Ping Kuai
- Institute of Health Service and Medical Information, Academy of Military Medical Sciences of the Chinese PLA, Beijing, 100850, China
| | - Li-Xin Shu
- Department of Pharmacy, Naval Medical University, Shanghai, 200433, China
| | - Guo-Fu Du
- Institute of Health Service and Medical Information, Academy of Military Medical Sciences of the Chinese PLA, Beijing, 100850, China
| | - Yu-Feng Zhao
- Department of Trauma Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China
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13
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van Roozendaal LM, van Gool MH, Sprooten RTM, Maesen BAE, Poeze M, Hulsewé KWE, Vissers YLJ, de Loos ER. Surgical treatment of bronchial rupture in blunt chest trauma: a review of literature. J Thorac Dis 2018; 10:5576-5583. [PMID: 30416808 DOI: 10.21037/jtd.2018.08.22] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Bronchial rupture by blunt chest trauma is rare. We present a case of bronchial injury after blunt chest trauma that was repaired surgically by primary reconstruction. We performed a review of literature to verify if primary reconstruction is suitable for the treatment of adult patients with blunt bronchial injury. A systematic search was conducted to identify cohort studies of bronchial rupture after blunt chest trauma in adult patients between 1985 and 2016 (n=215 articles). Studies were included concerning four or more patients and in case patient data could be extracted. This resulted in 19 articles for final review, consisting of 155 patients. Mean age of 155 patients was 28 (range, 18-60) years. The main bronchus was mostly injured (81%), in 5% including an injury of the trachea and in 14% lobar bronchi injury. Surgical repair was performed in 95% of patients: primary anastomosis in 72%, pneumonectomy in 15%, lobectomy or sleeve resection in 12% and other in 1%. Perioperative mortality rate was 10%. Other complications occurred in 17% (empyema, rebleeding, stenosis and fistula, among others). Data concerning the occurrence of long-term complications or long-term follow-up was not found. Statistical evaluation could not be performed due to lack of consistent patient data. No strong recommendations regarding type and timing of surgery can be made based on the available literature. Based on our multidisciplinary opinion we would advocate primary anastomosis in case of stable vital signs with the goal to preserve healthy lung parenchyma. Moreover, it may be considered transferring these rare cases to an experienced thoracic and trauma surgery center.
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Affiliation(s)
| | | | | | | | | | - Karel W E Hulsewé
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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14
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Bennett EE, Aljabari S, Short S, Scaife E, Poss WB. Perioperative extracorporeal membrane oxygenation in traumatic bronchial avulsion. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Rai G, Kamath GS, Vishnu R, Shanavas S. Tracheobronchial tear in chest trauma-a diagnostic perplexity. Indian J Thorac Cardiovasc Surg 2018; 34:409-412. [PMID: 33060904 DOI: 10.1007/s12055-017-0613-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/17/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022] Open
Abstract
Tracheobronchial injuries following blunt chest trauma are uncommon and diagnosed late. Tracheal rupture due to a fall from a height is rare. Early diagnosis and prompt treatment give gratifying results. We present a case of a 42-year-old man who was referred at our hospital with alleged history of fall from a height of about 12 ft from a tree. On presentation, the patient was haemodynamically stable and right-sided ICT was already inserted. There was a minimal surgical emphysema in the neck, a continuous air leak from the chest tube and a partially collapsed right lung on chest X-ray. After a few hours, he desaturated and was intubated. The right lung did not expand in spite of the second apical chest tube, and on ventilation, air leak increased. Tracheabronchial tear was suspected and computerised tomography scan revealed the site of damage and fibreoptic bronchoscopy confirmed the diagnosis. Emergency thoracotomy with primary repair of the right tracheabronchial tear was done. The patient recovered and post-operative course was uneventful.
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Affiliation(s)
- Guruprasad Rai
- Department of CardioThoracic Surgery, Kasturba Medical College, Manipal University, Manipal, Udupi, Karnataka India
| | - Ganesh Sevagur Kamath
- Department of CardioThoracic Surgery, Kasturba Medical College, Manipal University, Manipal, Udupi, Karnataka India
| | - Rajkamal Vishnu
- Department of CardioThoracic Surgery, Kasturba Medical College, Manipal University, Manipal, Udupi, Karnataka India
| | - Shaheem Shanavas
- Department of CardioThoracic Surgery, Kasturba Medical College, Manipal University, Manipal, Udupi, Karnataka India
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16
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Sharma S, Mishra B, Gupta A, Soni KD, Aggarwal R, Kumar S. Challenges in Management of Pediatric Life-threatening Neck and Chest Trauma. J Indian Assoc Pediatr Surg 2018; 23:10-15. [PMID: 29386758 PMCID: PMC5772087 DOI: 10.4103/jiaps.jiaps_49_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Neck and thoracic trauma in children pose unforeseen challenges requiring variable management strategies. Here, we describe some unusual cases. Patients and Methods: Pediatric cases of unusual neck and thoracic trauma prospectively managed from April 2012 to March 2014 at a Level 1 trauma center were studied for management strategies, outcome, and follow-up. Results: Six children with a median age of 5.5 (range 2–10) years were managed. Mechanism of injury was road traffic accident, fall from height and other accidental injury in 2, 3 and 1 patient respectively. The presentation was respiratory distress and quadriplegia, exposed heart, penetrating injury in neck, dysphagia and dyspnea, and swelling over the chest wall in 1, 1, 1, 2 and 1 cases respectively. Injuries included lung laceration, open chest wall, vascular injury of the neck, tracheoesophageal fistula (2), and chest wall posttraumatic pyomyositis. One patient had a flare of miliary tuberculosis. Immediate management included chest wall repair; neck exploration and repair, esophagostomy, gastroesophageal stapling, and feeding jejunostomy (followed by gastric pull-up 8 months later). Chest tube insertion and total parenteral nutrition was required in one each. 2 and 4 patients required tracheostomy and mechanical ventilation. The patient with gastric pull-up developed a stricture of the esophagogastric anastomosis that was revised at 26-month follow-up. At follow-up of 40–61 months, five patients are well. One patient with penetrating neck injury suffered from blindness due to massive hemorrhage from the vascular injury in the neck and brain ischemia with only peripheral vision recovery. Conclusion: Successful management of neck and chest wall trauma requires timely appropriate decisions with a team effort.
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Affiliation(s)
- Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Biplab Mishra
- Department of Trauma Surgery, JPN Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Department of Trauma Surgery, JPN Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Intensive and Critical Care, JPN Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department of Intensive and Critical Care, JPN Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Department of Trauma Surgery, JPN Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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17
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Mohammadzadeh AR, Kayalha H. Delayed diagnosis of bronchial transection following blunt chest trauma. Asian Cardiovasc Thorac Ann 2017; 25:540-543. [PMID: 28840745 DOI: 10.1177/0218492317728665] [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] [Indexed: 11/17/2022]
Abstract
Diagnosis of blunt tracheobronchial injuries can be challenging. These injuries may appear within months or years following the initial trauma. In general, diagnosis and treatment of delayed presentation of tracheobronchial injuries are uncommon. Herein, we present the case of a 48-year-old woman with complete transection of the right bronchus that was diagnosed 50 days after the initial trauma. Reconstructive surgery of the bronchus was performed successfully without any need for pulmonary resection.
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Affiliation(s)
- Ali Reza Mohammadzadeh
- 1 Department of Surgery, 48491 Velayat Hospital, Qazvin University of Medical Sciences , Qazvin, Iran
| | - Hamid Kayalha
- 2 Department of Anesthesiology, 48491 Velayat Hospital, Qazvin University of Medical Sciences , Qazvin, Iran
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18
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Lin WT, Su SY, Hsieh CF, Lai CC, Chao CM. Traumatic Thoracic Burst Fracture Associated with Bronchial Rupture. J Emerg Med 2017. [PMID: 28648782 DOI: 10.1016/j.jemermed.2017.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Rupture of, or injury to, the tracheobronchial tree is a rare occurrence in blunt chest trauma. CASE REPORT We present a case of bronchial rupture caused by fragmented bone from a spinal burst fracture after blunt chest trauma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although tracheobronchial injury is infrequent, clinicians should be aware of this possible complication after blunt chest trauma. Bronchoscopy can help in the diagnosis.
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Affiliation(s)
- Wei-Ting Lin
- Department of Orthopaedics, Chi Mei Medical Center, Tainan, Taiwan
| | - Shih-Yang Su
- Department of Emergency Medicine, Tainan Municipal Hospital, Tainan, Taiwan
| | - Cheng-Fang Hsieh
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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19
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Zhao XH, Zhang Y, Liang ZY, Zhang SY, Yu WQ, Huang FF. Full Airway Drainage by Fiber Bronchoscopy Through Artificial Airway in the Treatment of Occult Traumatic Atelectasis. Indian J Surg 2016; 77:1061-6. [PMID: 27011511 DOI: 10.1007/s12262-014-1145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 07/13/2014] [Indexed: 11/29/2022] Open
Abstract
The objective of this study is to investigate the effects of full airway drainage by fiber bronchoscopy through artificial airway in the treatment of traumatic atelectasis with occult manifestations. From May 2006 to May 2011, 40 cases of occult traumatic atelectasis were enrolled into our prospective study. Group A (n = 18) received drainage by nasal bronchoscope; group B underwent airway drainage by fiber bronchoscopy through artificial airway (n = 22). The effects of treatment were evaluated by the incidence of adult respiratory distress syndrome (ARDS), lung abscess, and the average length of hospital stay. Compared with nasal fiber-optic treatment, airway drainage by fiber bronchoscopy through artificial airway reduced the incidence of ARDS (p = 0.013) and lung abscess (p = 0.062) and shortened the mean length of stay (p = 0.018). Making the decision to create an artificial airway timely and carry out lung lavage by fiber bronchoscopy through artificial airway played a significant role in the treatment of occult traumatic atelectasis.
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Affiliation(s)
- Xue Hong Zhao
- The Department of Emergency Intensive Care Unit, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province China
| | - Yun Zhang
- The Department of General Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province China
| | - Zhong Yan Liang
- The Women's Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang Province China
| | - Shao Yang Zhang
- The Department of General Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province China
| | - Wen Qiao Yu
- The Department of Intensive Care Unit, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang Province China
| | - Fang-Fang Huang
- The Department of Surgical Intensive Care Unit, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province China
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20
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Anesthetic Considerations and Ventilation Strategies in Cardiothoracic Trauma. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0149-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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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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22
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Mimura T, Miyata Y, Tsutani Y, Takamizawa S, Nishijima E, Okada M. Complete transection of the left main bronchus caused by blunt thoracic trauma in a child treated by bronchoplasty and lung parenchyma preservation. Gen Thorac Cardiovasc Surg 2014; 64:113-5. [PMID: 24993603 DOI: 10.1007/s11748-014-0448-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/26/2014] [Indexed: 12/23/2022]
Abstract
Blunt bronchial injuries can be difficult to diagnose and can present months or years after an initial incident. The present case report describes complete transection of a major airway after a potentially fatal delayed diagnosis with a successful outcome after bronchoplasty without the removal of lung parenchyma.
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Affiliation(s)
- Takeshi Mimura
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | | | - Eiji Nishijima
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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23
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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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24
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Yadav N, Kumar A, Singh GP, Balakrishnan I, Aggarwal R, Prabhakar H. Anesthetic management of a patient with bronchopleural fistula following blunt trauma chest: A brief report. EGYPTIAN JOURNAL OF ANAESTHESIA 2014. [DOI: 10.1016/j.egja.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Naveen Yadav
- Department of Anaesthesiology, All India Institute of Medical Sciences , India
| | - Ajay Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences , India
| | - Gyaninder Pal Singh
- Department of Neuroanaesthesiology, All India Institute of Medical Sciences , India
| | - Ira Balakrishnan
- Department of Anaesthesiology, All India Institute of Medical Sciences , India
| | - Richa Aggarwal
- Department of Neuroanaesthesiology, All India Institute of Medical Sciences , India
| | - Hemanshu Prabhakar
- Department of Neuroanaesthesiology, All India Institute of Medical Sciences , India
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25
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Abstract
Tracheobronchial injuries (TBIs) are caused by blunt, penetrating injury or by iatrogenic damage. Most injuries are life threatening and need early and skillful airway management. Bronchoscopy remains the gold standard of diagnosis. Penetrating TBI always needs blunt trauma, and iatrogenic TBI sometimes needs surgical exploration and reconstruction, which is performed after sparing debridement with primary repair and wound closure. Prognosis mainly depends on associated injuries and comorbidities in terms of tracheal membrane laceration.
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Affiliation(s)
- Stefan Welter
- Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, University Clinic, University of Duisburg-Essen, Tüschener Weg 40, Essen 45239, Germany.
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26
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Hoffman PJ, Cooke DT, Zeki AA, Black H. A 40-year-old woman with cough and dyspnea 2 months after a motorcycle accident. Chest 2014; 144:1720-1723. [PMID: 24189866 DOI: 10.1378/chest.13-0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Paul J Hoffman
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, Davis Medical Center, Sacramento, CA.
| | - David T Cooke
- Section of General Thoracic Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Amir A Zeki
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, Davis Medical Center, Sacramento, CA
| | - Hugh Black
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, Davis Medical Center, Sacramento, CA
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27
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Blackney KA, Alfille PH. Anesthetic Management of a Delayed Carinal Resection Following Traumatic Disruption. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojanes.2014.410034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Kim JH, Kim KW, Cho CS, Lee SI, Kim JY, Kim KT, Choe WJ, Park JS, Kim JW. Lobar Bronchial Rupture with Persistent Atelectasis after Blunt Trauma. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.4.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jun Hyun Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | | | - Chu Sung Cho
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang-il Lee
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Ji Yeon Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung-Tae Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Won Joo Choe
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jang Su Park
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jung Won Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
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29
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Heart, tracheo-bronchial and thoracic spine trauma. Succesful multidisciplinary management: a challenging thoracic politrauma. JOURNAL OF ACUTE DISEASE 2014. [DOI: 10.1016/s2221-6189(14)60055-x] [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] Open
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30
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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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31
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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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32
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Delayed presentation of traumatic bronchial tear and successful repair. Indian J Thorac Cardiovasc Surg 2011. [DOI: 10.1007/s12055-011-0122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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