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Wei S, Zhang Y, Luo F, Duan K, Li M, Lv G. Tissue-engineered tracheal implants: Advancements, challenges, and clinical considerations. Bioeng Transl Med 2024; 9:e10671. [PMID: 39036086 PMCID: PMC11256149 DOI: 10.1002/btm2.10671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/28/2024] [Accepted: 04/08/2024] [Indexed: 07/23/2024] Open
Abstract
Restoration of extensive tracheal damage remains a significant challenge in respiratory medicine, particularly in instances stemming from conditions like infection, congenital anomalies, or stenosis. The trachea, an essential element of the lower respiratory tract, constitutes a fibrocartilaginous tube spanning approximately 10-12 cm in length. It is characterized by 18 ± 2 tracheal cartilages distributed anterolaterally with the dynamic trachealis muscle located posteriorly. While tracheotomy is a common approach for patients with short-length defects, situations requiring replacement arise when the extent of lesion exceeds 1/2 of the length in adults (or 1/3 in children). Tissue engineering (TE) holds promise in developing biocompatible airway grafts for addressing challenges in tracheal regeneration. Despite the potential, the extensive clinical application of tissue-engineered tracheal substitutes encounters obstacles, including insufficient revascularization, inadequate re-epithelialization, suboptimal mechanical properties, and insufficient durability. These limitations have led to limited success in implementing tissue-engineered tracheal implants in clinical settings. This review provides a comprehensive exploration of historical attempts and lessons learned in the field of tracheal TE, contextualizing the clinical prerequisites and vital criteria for effective tracheal grafts. The manufacturing approaches employed in TE, along with the clinical application of both tissue-engineered and non-tissue-engineered approaches for tracheal reconstruction, are discussed in detail. By offering a holistic view on TE substitutes and their implications for the clinical management of long-segment tracheal lesions, this review aims to contribute to the understanding and advancement of strategies in this critical area of respiratory medicine.
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Affiliation(s)
- Shixiong Wei
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunChina
- Department of Thoracic SurgeryThe First Hospital of Jilin UniversityChangchunChina
| | - Yiyuan Zhang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunChina
- Department of Thoracic SurgeryThe First Hospital of Jilin UniversityChangchunChina
| | - Feixiang Luo
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunChina
| | - Kexing Duan
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunChina
| | - Mingqian Li
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunChina
| | - Guoyue Lv
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunChina
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2
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Vlahou A, Ampatzidou F, Bismpa K, Karaiskos T. Conservative Management of Large Post-Intubation Tracheal Laceration. Ann Card Anaesth 2024; 27:85-88. [PMID: 38722131 PMCID: PMC10876129 DOI: 10.4103/aca.aca_106_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 05/12/2024] Open
Abstract
ABSTRACT Tracheal rupture is a very rare but life-threatening complication of endotracheal intubation. It is more common in women and patients older than 50 years old. Overinflation of endotracheal tube cuff and tracheal wall weakening are the most important pathogenetic mechanisms. Laceration sites are located in the posterior membranous wall in most cases. Subcutaneous and mediastinal emphysema and respiratory distress are the most common manifestations. A 55-year-old female presented with postoperative subcutaneous and mediastinal emphysema without dyspnea because of a tear in the posterior tracheal wall. The diagnosis was based on clinical manifestation, chest computer tomography scans (CT), and endoscopic findings. A conservative approach by broad-spectrum antibiotic therapy was decided because of patients' vital signs stability and the absence of esophageal injury. The follow-up showed that there was no lesion in the posterior tracheal wall. Our case showed that in clinically stable patients without mediastinitis and with spontaneous breathing, conservative management of tracheal tears is a safe procedure.
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Affiliation(s)
- Athanasia Vlahou
- Department of Cardiothoracic, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Kalliopi Bismpa
- Department of Computed Tomography and Magnetic Resonance Imaging, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Theodoros Karaiskos
- Department of Cardiothoracic, G. Papanikolaou Hospital, Thessaloniki, Greece
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3
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Passera E, Orlandi R, Calderoni M, Cassina EM, Cioffi U, Guttadauro A, Libretti L, Pirondini E, Rimessi A, Tuoro A, Raveglia F. Post-intubation iatrogenic tracheobronchial injuries: The state of art. Front Surg 2023; 10:1125997. [PMID: 36860949 PMCID: PMC9968843 DOI: 10.3389/fsurg.2023.1125997] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
Iatrogenic tracheobronchial injury (ITI) is an infrequent but potentially life-threatening disease, with significant morbidity and mortality rates. Its incidence is presumably underestimated since several cases are underrecognized and underreported. Causes of ITI include endotracheal intubation (EI) or percutaneous tracheostomy (PT). Most frequent clinical manifestations are subcutaneous emphysema, pneumomediastinum and unilateral or bilateral pneumothorax, even if occasionally ITI can occur without significant symptoms. Diagnosis mainly relies on clinical suspicion and CT scan, although flexible bronchoscopy remains the gold standard, allowing to identify location and size of the injury. EI and PT related ITIs more commonly consist of longitudinal tear involving the pars membranacea. Based on the depth of tracheal wall injury, Cardillo and colleagues proposed a morphologic classification of ITIs, attempting to standardize their management. Nevertheless, in literature there are no unambiguous guidelines on the best therapeutic modality: management and its timing remain controversial. Historically, surgical repair was considered the gold standard, mainly in high-grade lesions (IIIa-IIIb), carrying high morbi-mortality rates, but currently the development of promising endoscopic techniques through rigid bronchoscopy and stenting could allow for bridge treatment, delaying surgical approach after improving general conditions of the patient, or even for definitive repair, ensuring lower morbi-mortality rates especially in high-risk surgical candidates. Our perspective review will cover all the above issues, aiming at providing an updated and clear diagnostic-therapeutic pathway protocol, which could be applied in case of unexpected ITI.
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Affiliation(s)
- Eliseo Passera
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy,Correspondence: Eliseo Passera Riccardo Orlandi
| | - Riccardo Orlandi
- Department of Thoracic Surgery, University of Milan, Milan, Italy,Correspondence: Eliseo Passera Riccardo Orlandi
| | - Matteo Calderoni
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Lidia Libretti
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Emanuele Pirondini
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Arianna Rimessi
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Antonio Tuoro
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Federico Raveglia
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
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4
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Cardillo G, Ricciardi S, Forcione AR, Carbone L, Carleo F, Di Martino M, Jaus MO, Perdichizzi S, Scarci M, Ricci A, Dello Iacono R, Lucantoni G, Galluccio G. Post-intubation tracheal lacerations: Risk-stratification and treatment protocol according to morphological classification. Front Surg 2022; 9:1049126. [PMID: 36504581 PMCID: PMC9727090 DOI: 10.3389/fsurg.2022.1049126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Post-intubation tracheal laceration (PITL) is a rare condition (0.005% of intubations). The treatment of choice has traditionally been surgical repair. Following our first report in 2010 of treatment protocol tailored to a risk-stratified morphological classification there is now clear evidence that conservative therapy represents the gold standard in the majority of patients. In this paper we aim to validate our risk-stratified treatment protocol through the largest ever reported series of patients. Methods This retrospective analysis is based on a prospectively collected series (2003-2020) of 62 patients with PITL, staged and treated according to our revised morphological classification. Results Fifty-five patients with Level I (#8), II (#36) and IIIA (#11) PITL were successfully treated conservatively. Six patients with Level IIIB injury and 1 patient with Level IV underwent a surgical repair of the trachea. No mortality was reported. Bronchoscopy confirmed complete healing in all patients by day 30. Statistical analysis showed age only to be a risk factor for PITL severity. Conclusions Our previously proposed risk-stratified morphological classification has been validated as the major tool for defining the type of treatment in PITL.
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Affiliation(s)
- Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Carlo Forlanini Hospital, Rome, Italy,Unicamillus–Saint Camillus University of Health Sciences, Rome, Italy
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Carlo Forlanini Hospital, Rome, Italy,PhD Program, Alma Mater Studiorum, University of Bologna, Bologna, Italy,Correspondence: Sara Ricciardi
| | - Anna Rita Forcione
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Carlo Forlanini Hospital, Rome, Italy
| | - Luigi Carbone
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Carlo Forlanini Hospital, Rome, Italy
| | - Francesco Carleo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Carlo Forlanini Hospital, Rome, Italy
| | - Marco Di Martino
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Carlo Forlanini Hospital, Rome, Italy
| | - Massimo O. Jaus
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Carlo Forlanini Hospital, Rome, Italy
| | | | - Marco Scarci
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Alberto Ricci
- Unit of Pulmonology, Sapienza University of Rome, San Andrea Hospital, Rome, Italy
| | - Raffaele Dello Iacono
- Unit of Pulmonology and Thoracic Endoscopy, Azienda Ospedaliera San Camillo-Forlanini,
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Martínez Juste JF. Laceración traqueal tras realizar una intubación con videolaringoscopio C-MAC ®. Reporte de caso. REVISTA DE LA FACULTAD DE MEDICINA 2022. [DOI: 10.15446/revfacmed.v71n2.96868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La laceración traqueal post-intubación es una complicación con una baja incidencia, pero que, debido a su relevancia clínica y alto riesgo de mortalidad, debe ser sospechada en casos de intubación endotraqueal.
Presentación del caso. Mujer de 74 años con antecedentes médicos de hipertensión arterial e insuficiencias mitral y tricuspídea que fue sometida a colecistectomía laparoscópica bajo anestesia general en un hospital de tercer nivel de Zaragoza, España, donde se utilizó un videolaringoscopio C-MAC® para realizar la intubación. La paciente, 20 minutos después de la extubación, presentó hemoptisis, disnea y disminución de la saturación de oxígeno, por lo que se realizó una fibrobroncoscopia, en la cual se evidenció una laceración traqueal sangrante de 1.5 cm. Se inició tratamiento antibiótico endovenoso y mediante radiografía de tórax y tomografía axial computarizada se descartaron complicaciones graves como neumotórax, neumomediastino o rotura traqueal. Durante el período de observación, la paciente tuvo un nivel normal de oxígeno en la sangre, su condición hemodinámica permaneció estable, y recibió el alta hospitalaria a las 72 horas.
Conclusiones. Debido a la alta mortalidad asociada a las laceraciones traqueales, se requiere un alto índice de sospecha clínica, en particular en pacientes con factores de riesgo para este tipo de lesiones y en casos de intubación difícil, para no demorar el inicio de medidas diagnósticas y terapéuticas oportunas, disminuyendo así las posibles complicaciones y mejorando el pronóstico. Además, estas lesiones requieren un manejo individualizado por parte de un equipo multidisciplinario.
riesgo de mortalidad, debe ser sospechada en casos de intubaciónendotraqueal.
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6
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Iatrogenic Tracheal Rupture Related to Prehospital Emergency Intubation in Adults: A 15-Year Single Center Experience. Prehosp Disaster Med 2022; 37:57-64. [PMID: 35012697 DOI: 10.1017/s1049023x21001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Iatrogenic tracheal rupture is an unusual and severe complication that can be caused by tracheal intubation. The frequency, management, and outcome of iatrogenic tracheal rupture due to prehospital emergency intubation in adults by emergency response physicians has not yet been sufficiently explored. METHODS Adult patients with iatrogenic tracheal ruptures due to prehospital emergency intubation admitted to an academic referral center over a 15-year period (2004-2018) with consideration of individual risk factors were analyzed. RESULTS Thirteen patients (eight female) with a mean age of 67 years met the inclusion criteria and were analyzed. Of these, eight tracheal ruptures (62%) were caused during the airway management of cardiopulmonary resuscitation (CPR). Stylet use and difficult laryngoscopy requiring multiple attempts were documented in eight cases (62%) and four cases (30%), respectively. Seven patients (54%) underwent surgery, while six patients (46%) were treated conservatively. The overall 30-day mortality was 46%; five patients died due to their underlying emergencies and one patient died of tracheal rupture. Three survivors (23%) recovered with severe neurological sequelae and four (30%) were discharged in good neurological condition. Survivors had significantly smaller mean rupture sizes (2.7cm versus 6.3cm; P <.001) and less cutaneous emphysema (n = 2 versus n = 6; P = .021) than nonsurvivors. CONCLUSIONS Iatrogenic tracheal rupture due to prehospital emergency intubation is a rare complication. Published risk factors are not consistently present and may not be applicable to identify patients at high risk, especially not in rescue situations. Treatment options depend on individual patient condition, whereas outcome largely depends on the underlying disease and rupture extension.
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7
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Soriano L, Khalid T, Whelan D, O'Huallachain N, Redmond KC, O'Brien FJ, O'Leary C, Cryan SA. Development and clinical translation of tubular constructs for tracheal tissue engineering: a review. Eur Respir Rev 2021; 30:30/162/210154. [PMID: 34750116 DOI: 10.1183/16000617.0154-2021] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Effective restoration of extensive tracheal damage arising from cancer, stenosis, infection or congenital abnormalities remains an unmet clinical need in respiratory medicine. The trachea is a 10-11 cm long fibrocartilaginous tube of the lower respiratory tract, with 16-20 tracheal cartilages anterolaterally and a dynamic trachealis muscle posteriorly. Tracheal resection is commonly offered to patients suffering from short-length tracheal defects, but replacement is required when the trauma exceeds 50% of total length of the trachea in adults and 30% in children. Recently, tissue engineering (TE) has shown promise to fabricate biocompatible tissue-engineered tracheal implants for tracheal replacement and regeneration. However, its widespread use is hampered by inadequate re-epithelialisation, poor mechanical properties, insufficient revascularisation and unsatisfactory durability, leading to little success in the clinical use of tissue-engineered tracheal implants to date. Here, we describe in detail the historical attempts and the lessons learned for tracheal TE approaches by contextualising the clinical needs and essential requirements for a functional tracheal graft. TE manufacturing approaches explored to date and the clinical translation of both TE and non-TE strategies for tracheal regeneration are summarised to fully understand the big picture of tracheal TE and its impact on clinical treatment of extensive tracheal defects.
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Affiliation(s)
- Luis Soriano
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Joint first authors
| | - Tehreem Khalid
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Joint first authors
| | - Derek Whelan
- Dept of Mechanical, Biomedical and Manufacturing Engineering, Munster Technological University, Cork, Ireland
| | - Niall O'Huallachain
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen C Redmond
- National Cardio-thoracic Transplant Unit, Mater Misericordiae University Hospital and UCD School of Medicine, Dublin, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Cian O'Leary
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Both authors contributed equally
| | - Sally-Ann Cryan
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland .,Tissue Engineering Research Group, Dept of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Centre for Research in Medical Devices (CÚRAM), RCSI University of Medicine and Health Sciences, Dublin, Ireland.,SFI Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI University of Medicine and Health Sciences and Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Both authors contributed equally
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8
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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] [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.
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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
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9
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Krämer S, Broschewitz J, Kirsten H, Sell C, Eichfeld U, Struck MF. Prognostic Factors for Iatrogenic Tracheal Rupture: A Single-Center Retrospective Cohort Study. J Clin Med 2020; 9:jcm9020382. [PMID: 32024043 PMCID: PMC7074133 DOI: 10.3390/jcm9020382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/20/2020] [Accepted: 01/29/2020] [Indexed: 01/02/2023] Open
Abstract
Iatrogenic tracheal ruptures are rare but severe complications of medical interventions. The main goal of this study was to explore prognostic factors for all-cause mortality and rupture-related (adjusted) mortality. We retrospectively analyzed patients admitted to an academic referral center over a 15-year period (2004-2018). Fifty-four patients met the inclusion criteria, of whom 36 patients underwent surgical repair and 18 patients were treated conservatively. In a 90-day follow-up, the all-cause mortality was 50%, while the adjusted mortality was 13%. Rupture length was identified as a predictor for all-cause mortality (area under the curve, 0.84; 95% confidence interval (CI) 0.74-0.94) with a cutoff rupture length of 4.5 cm (sensitivity, 0.70; specificity, 0.81). Multivariate analysis confirmed rupture length as a prognostic factor for all-cause mortality (adjusted hazard ratio (HR) 1.5; 95% CI 1.2-1.9; p = 0.001), but not for adjusted mortality (HR 1.5; 95% CI 0.97-2.3; p = 0.068), while mediastinitis predicted adjusted mortality (HR 5.8; 95% CI 1.1-31.7; p = 0.042), but not all-cause mortality (HR 1.6; 95% CI 0.7-3.5; p = 0.243). The extent of iatrogenic tracheal rupture and mediastinitis might be relevant prognostic factors for all-cause mortality and adjusted mortality, respectively.
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Affiliation(s)
- Sebastian Krämer
- Division of Thoracic Surgery, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany; (S.K.); (J.B.); (C.S.); (U.E.)
| | - Johannes Broschewitz
- Division of Thoracic Surgery, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany; (S.K.); (J.B.); (C.S.); (U.E.)
| | - Holger Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany;
| | - Carolin Sell
- Division of Thoracic Surgery, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany; (S.K.); (J.B.); (C.S.); (U.E.)
| | - Uwe Eichfeld
- Division of Thoracic Surgery, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany; (S.K.); (J.B.); (C.S.); (U.E.)
| | - Manuel Florian Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-151-2886-1631
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10
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Fiorelli A, Messina G, Santoriello C, Liguori G, Arrigo E, Caronia FP, Santini M. Fibrin glue to fix metallic airway stent. J Thorac Dis 2019; 11:E4-E7. [PMID: 30863614 DOI: 10.21037/jtd.2018.12.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Gaetana Messina
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Giovanni Liguori
- Anaestesia and Intensive care Unit, Cardarelli Hospital, Naples, Italy
| | - Ettore Arrigo
- Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Viagrande (CT), Italy
| | | | - Mario Santini
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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11
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Pota V, Sansone P, Fiorelli A, Passavanti MB, D'Amora M, Vosa P, Bignami E, Pace MC, Aurilio C. Anesthetic consideration for airway management of patients undergoing endoscopic fibrin glue treatment of tracheobronchial rupture: a case series of three patients. Perioper Med (Lond) 2018; 7:31. [PMID: 30574292 PMCID: PMC6299653 DOI: 10.1186/s13741-018-0111-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/30/2018] [Indexed: 01/31/2023] Open
Abstract
Tracheobronchial ruptures are very severe and life-threatening injuries. The origin of such airway damage is trauma or an iatrogenic event. Last year, we operated on three different cases of tracheal ruptures using endobronchial suture with three different airway management. We exposed the description of three different techniques to manage the airway during an endoscopic suture of tracheobronchial rupture with fibrin glue (laryngeal mask, orotracheal tube positioned distally the lesion, one lung ventilation with a small size single tube). Using this kind of technique, we have obtained a protective ventilation on tracheal rupture, a rapid healing, and fast recovery of spontaneous breathing.
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Affiliation(s)
- Vincenzo Pota
- Anaesthesia and Intensive Care Unit, Department of Women, Children, General and Specialistic Surgery, L. Vanvitelli University of Campania, Naples, Italy
| | - Pasquale Sansone
- Anaesthesia and Intensive Care Unit, Department of Women, Children, General and Specialistic Surgery, L. Vanvitelli University of Campania, Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, L. Vanvitelli University of Campania, Naples, Italy
| | - Maria Beatrice Passavanti
- Anaesthesia and Intensive Care Unit, Department of Women, Children, General and Specialistic Surgery, L. Vanvitelli University of Campania, Naples, Italy
| | - Mauro D'Amora
- 3Anaesthesia and Intensive Care Unit, San Carlo Hospital, Potenza, Italy
| | - Paola Vosa
- Anaesthesia and Intensive Care Unit, A.O.R.N. Santobono Pausillipon, Naples, Italy
| | - Elena Bignami
- 5Anaesthesia, Intensive Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maria Caterina Pace
- Anaesthesia and Intensive Care Unit, Department of Women, Children, General and Specialistic Surgery, L. Vanvitelli University of Campania, Naples, Italy
| | - Caterina Aurilio
- Anaesthesia and Intensive Care Unit, Department of Women, Children, General and Specialistic Surgery, L. Vanvitelli University of Campania, Naples, Italy
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