Injuries of the trachea and major bronchi

Management of a patient with a complete rupture of a main bronchus in a community hospital

We describe the successful use of a portable extracorporeal membrane oxygenation machine for a patient with complete rupture of the left main bronchus after a road crash. The machine was used before and during left main bronchus reanastomosis at a community hospital 30 km from Melbourne, and then during acute interhospital transfer.

Fiberoptic bronchoscopy in the evaluation of acute chest and upper airway trauma

To determine the utility of fiberoptic bronchoscopy (FFB) in the short-term evaluation of patients with trauma, we identified 53 consecutive patients (45 male patients; mean age, 36 years) seen over a ten-year period who had FFB performed within the first three days of trauma to the chest and upper airway. There were eight deaths. Fifty patients had blunt trauma to the chest. These were mostly due to motor vehicle accidents (38 patients), crushing injuries (three patients), and falls (three patients). In addition, there were three patients with trauma to the neck. Physical and radiographic findings included pneumothorax (37 patients), subcutaneous emphysema (31), pulmonary contusion (22), hemothorax (21), mediastinal emphysema (16), flail chest (ten), atelectasis (ten), and hemoptysis (five). The FFB was of diagnostic use in 28 patients (53 percent) by revealing complete tracheal transection (one patient), tracheal laceration (three), complete bronchial transection (one), bronchial laceration (two), bronchial contusion (two), ongoing distal hemorrhage/pulmonary contusion (seven), aspirated material (three), mucous plugging/thick secretions (eight), and supraglottic lesions (three). One of the cases of tracheal laceration was not fully appreciated as a complete transection. We conclude that FFB has value in the short-term evaluation of patients with trauma.

Diagnosis and long-term follow-up of major bronchial disruptions due to nonpenetrating trauma

From 1966 through 1978, 13 patients were treated for major bronchial disruptions due to nonpenetrating trauma. In 10 patients the diagnosis was made early, and operation was carried out in all of them. Four of the 6 patients with main bronchus avulsion had primary repair and all 4 patients with lobar rupture underwent lobectomy. One patient had a pneumonectomy. There was 1 operative death. In 3 patients the diagnosis was made more than a month after the injury. A bronchoplastic repair was done in every patient. All 7 patients who had repair of a transected main bronchus were assessed 2 to 14 years after operation (average, 7 1/2 years). Flow-volume curves on air and air-helium were normal, indicating no major airway obstruction; this finding was confirmed by clinical and bronchoscopic examinations. Pulmonary diffusing capacity for carbon monoxide was also normal in all patients. Volume measurements by closed circuit method and by body plethysmography showed restriction in 1 patient but no major air trapping. Perfusion/ventilation scans showed homogeneous distribution of air and blood flow in the lung.

Management of tracheobronchial disruption secondary to nonpenetrating trauma

The pathogenesis, pathology, clinical presentation, diagnosis and management of tracheo-bronchial injuries secondary to nonpenetrating thoracic trauma are discussed.

Extensive linear "blow-out" of the thoracic membranes trachea with innominate artery avulsion secondary to blunt chest trauma

The successful management of extensive rupture of the entire intrathoracic membranous trachea and an avulsed innominate artery is presented. Taken separately, the two entities are in themselves rare following blunt trauma to the chest. Ventilatory and anesthetic control during repair of this injury is presented.