1
|
Herrmann D, Hecker E. [Tracheobronchial Injuries]. Zentralbl Chir 2024; 149:275-285. [PMID: 37884026 DOI: 10.1055/a-2182-7126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Tracheobronchial injury is a rare, but potentially life-threatening condition. These injuries are associated with high morbidity and mortality, which is ascribed to underlying diseases and additional injuries. Lacerations of the airway are differentiated into iatrogenic and non-iatrogenic injuries, while the group of non-iatrogenic lesions are grouped into blunt and penetrating traumas.The exact incidence of tracheobronchial injury is unknown, because many iatrogenic injuries occur without symptoms and most patients after traumatic laceration die before inpatient treatment. All patients with suspicion of airway injury require fast and accurate management.Common signs and symptoms are dyspnoea, haemoptysis, stridor and subcutaneous emphysema.Bronchoscopy is the most important tool for diagnosis and in several cases also for initial treatment.Further management depends on the patient's clinical condition and findings of bronchoscopy and computed tomography. Surgery has been the cornerstone of therapy, but in selected patients bronchoscopic stent implantation or conservative management must be discussed.
Collapse
Affiliation(s)
- Dominik Herrmann
- Klinik für Thoraxchirurgie, Thoraxzentrum Ruhrgebiet - EVK Herne, Herne, Deutschland
| | - Erich Hecker
- Klinik für Thoraxchirurgie, Thoraxzentrum Ruhrgebiet - EVK Herne, Herne, Deutschland
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Kalverkamp S, Störmann P, Graeff P, Raab S. [Traumatic Tracheobronchial Injuries - Recommendation of the Interdisciplinary Working Group of the DGT and DGU to Establish a Uniform Classification for Diagnostics and Therapy]. Zentralbl Chir 2023; 148:85-92. [PMID: 36822184 DOI: 10.1055/a-1970-3555] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Traumatic tracheobronchial injuries are extremely rare. In comparison, iatrogenic injuries are somewhat more common. A literature search revealed that there is a large number of case reports and small case series for this clinical entity. There are hardly any reviews and they usually have a low level of evidence. One reason for this is the lack of a classification to allow comparison of the individual cases with each other. There is only one classification for iatrogenic injuries of the posterior tracheal wall, which the authors modified and expanded with regard to traumatic tracheobronchial injuries. This classification was extended by the authors to also include traumatic injuries. A three-digit classification is presented here. The grading of the injury covers the entire spectrum of injury patterns, from peribronchial emphysema to wall injuries of different depths to subtotal and complete rupture of the bronchus. In addition, the anatomical location and the cause of the injury were added to the classification. The levels of injury in the tracheobronchial tree are distinguished anatomically. The third digit distinguishes traumatic, iatrogenic and spontaneous injuries. On the basis of the three-digit classification resulting from these parameters, it is possible to group individual cases together and to develop recommendations for diagnostics and therapy.
Collapse
Affiliation(s)
| | - Philipp Störmann
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Pascal Graeff
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stephan Raab
- Herz- und Thoraxchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| |
Collapse
|
4
|
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.
Collapse
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,
| | | | | |
Collapse
|
5
|
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.
Collapse
|
6
|
Evermann M, Roesner I, Denk-Linnert DM, Taghavi S, Klepetko W, Hoetzenecker K, Schweiger T. Cervical Repair of Iatrogenic Tracheobronchial Injury by Tracheal T-Incision. Ann Thorac Surg 2022; 114:1863-1870. [PMID: 35346636 DOI: 10.1016/j.athoracsur.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/06/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tracheobronchial injury is a rare but potentially life-threatening condition. Various surgical treatment options have been described for symptomatic patients with full-thickness injury. However, studies comprising a meaningful number of patients are sparse. METHODS We retrospectively analyzed all patients who received surgical repair of tracheobronchial injury between January 1999 and May 2021 at the Department of Thoracic Surgery, Medical University of Vienna. Patient characteristics, surgical variables, postoperative morbidity, and mortality were retrieved and analyzed. RESULTS Fifty patients with a median age of 68 years (range, 17-88) were included in the analysis. The etiologies of the iatrogenic tracheobronchial injuries were emergency intubation (48%), elective percutaneous dilatation tracheostomy (38%), or elective intubation (14%). The most common location of tracheobronchial injuries was distal third (28%) with a median length of 50 mm (range, 20-100 mm). The surgical approach was cervicotomy in 52%, thoracotomy in 38%, sternotomy in 2%, and combined approaches in 8% of cases. Moreover, intraoperative venovenous (n = 4) or venoarterial (n = 2) extracorporeal membrane oxygenation support was required in 12% of cases. Procedure-related mortality was 0%. However, as patients with tracheobronchial injury usually have severe comorbidities, the rate of patients discharged alive from the intensive care unit was only 66%. The median follow-up period of discharged patients was 5.5 months (range, 0.7-209). Airway stenosis or dehiscence was not observed in any patient. CONCLUSIONS Surgical repair of tracheobronchial injuries can be performed safely with a low procedure-related morbidity. If possible, the less-invasive cervical access should be preferred for patients with tracheobronchial injury, even for injuries extending to the main bronchi.
Collapse
Affiliation(s)
- Matthias Evermann
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Imme Roesner
- Division of Phoniatrics and Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Doris-Maria Denk-Linnert
- Division of Phoniatrics and Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Shahrokh Taghavi
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
7
|
Wang R, Wang Q, Jiang S, Chen C, Zheng J, Liu H, Liang X, Chen Z, Wang H, Guo Z, Liang W, He J, Liang H, Wang W. Spontaneous Ventilation Video-Assisted Thoracoscopic Surgery for Non-small-cell Lung Cancer Patients With Poor Lung Function: Short- and Long-Term Outcomes. Front Surg 2022; 9:800082. [PMID: 35310434 PMCID: PMC8928927 DOI: 10.3389/fsurg.2022.800082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe goal of this study was to explore the feasibility and safety of spontaneous ventilation video-assisted thoracoscopic surgery (SV-VATS) for non-small-cell lung cancer (NSCLC) patients with poor lung function.MethodsNSCLC patients with poor lung function who underwent SV-VATS or mechanical ventilation VATS (MV-VATS) from 2011 to 2018 were analyzed. 1:2 Propensity score matching (PSM) was applied, and the short- and long-term outcomes between the SV-VATS group and the MV-VATS group were compared.ResultsAnesthesia time (226.18 ± 64.89 min vs. 248.27 ± 76.07 min; P = 0.03), operative time (140.85 ± 76.07 min vs. 163.12 ± 69.37 min; P = 0.01), days of postoperative hospitalization (7.29 ± 3.35 days vs. 8.40 ± 7.89 days; P = 0.04), and days of chest tube use (4.15 ± 2.89 days vs. 5.15 ± 3.54 days; P = 0.01), the number of N1 station lymph node dissection (2.94 ± 3.24 vs. 4.34 ± 4.15; P = 0.005) and systemic immune-inflammation index (3855.43 ± 3618.61 vs. 2908.11 ± 2933.89; P = 0.04) were lower in SV-VATS group. Overall survival and disease-free survival were not significantly different between the two groups (OS: HR 0.66, 95% CI: 0.41–1.07, P = 0.09; DFS: HR 0.78, 95% CI: 0.42–1.45, P = 0.43).ConclusionsComparable short-term and long-term outcomes indicated that SV-VATS is a feasible and safe method and might be an alternative to MV-VATS when managing NSCLC patients with poor lung function.
Collapse
Affiliation(s)
- Runchen Wang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Qixia Wang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Shunjun Jiang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chao Chen
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Jianqi Zheng
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hui Liu
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xueqing Liang
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhuxing Chen
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haixuan Wang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhuoxuan Guo
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Hengrui Liang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Hengrui Liang
| | - Wei Wang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Wei Wang
| |
Collapse
|
8
|
Andrade-Alegre R, Díaz A, Juárez H. Terapia de presión negativa para pacientes con enfisema subcutáneo y neumomediastino masivo. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Se han descrito diversas técnicas para el tratamiento del enfisema subcutáneo y del neumomediastino. Algunos pacientes con pequeñas perforaciones traqueales pueden ser manejados de forma expectante, salvo que requieran ventilación mecánica. Se presentan las imágenes de un paciente con enfisema subcutáneo y neumomediastino no candidato a cirugía y quien fue tratado exitosamente con terapia de presión negativa.
Collapse
|
9
|
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.
Collapse
|
10
|
Jesani S, Elkattawy S, Ayad S, El-Feki I, Chapla R, Patel H, Garg V. A Rare Yet Morbid Complication of Endotracheal Intubation: Tracheal Rupture. Eur J Case Rep Intern Med 2021; 8:002722. [PMID: 34377703 DOI: 10.12890/2021_002722] [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: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/05/2022] Open
Abstract
Tracheal tears are an uncommon phenomenon that can occur due to infection, blunt or penetrating trauma or iatrogenic causes secondary to endotracheal intubation or procedures such as bronchoscopy. Post-intubation tracheal laceration is a very rare yet serious complication with high morbidity and mortality rates. Here, we report the case of a 53-year-old woman with a medical history of hypertension who presented with complaints of facial swelling after undergoing arthroscopic debridement of the coracoacromial ligament as well as partial resection of the acromion for impingement of the right shoulder under general anaesthesia. The patient was found to have extensive pneumomediastinum, subcutaneous emphysema, and a large tracheal tear. We aim to highlight this rare complication of endotracheal intubation, discuss the presenting signs and symptoms, and explore the various management options. LEARNING POINTS Iatrogenic tracheal laceration after intubation is a rare but life-threatening complication.Prompt recognition and treatment is required to reduce morbidity and mortality.
Collapse
Affiliation(s)
- Shruti Jesani
- Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Sherif Elkattawy
- Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Sarah Ayad
- Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | | | - Rani Chapla
- St George's University, Grenada, West Indies
| | - Henal Patel
- St George's University, Grenada, West Indies
| | - Vipin Garg
- Pulmonology, Trinitas Regional Medical Center, Elizabeth, NJ, USA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|