Tracheobronchial injury due to blunt chest trauma

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Abstract

Tracheobronchial avulsion resulting from blunt trauma is a very rare and serious condition, mostly due to high-speed traffic crashes. In this article, we briefly report the case of an 18-year-old man who was injured in a car accident and because of massive persistent air leakage (despite appropriate chest tube drainage), deemed to have a deep tracheobronchial injury. Due to a rapid drop in the patient's O ₂ saturation, he underwent an anterolateral thoracotomy. Endotracheal intubation was performed under direct visualization. The right mainstem bronchus was disrupted from the carina with a 1.5-cm stump remaining on the carina, and the remainder was crushed to the origin of the right superior lobe bronchus. Hence, a right superior lobectomy was performed and the postoperative course was uneventful.

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Most cited references 18

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Blunt tracheobronchial injuries: treatment and outcomes.

Andy Kiser, Sean O’Brien, Frank Detterbeck (2001)

Tracheobronchial injury is a recognized, yet uncommon, result of blunt trauma to the thorax. Often the diagnosis and treatment are delayed, resulting in attempted surgical repair months or even years after the injury. This report is an extensive review of the literature on tracheobronchial ruptures that examines outcomes and their association with the time from injury to diagnosis. We reviewed all patients with blunt tracheobronchial injuries published in the literature to determine the anatomic location of the injury, mechanism of the injury, time until diagnosis and treatment, and outcome. Only patients with blunt intrathoracic tracheobronchial traumas were included. We identified 265 patients reported between 1873 and 1996. Motor vehicle accidents were the most frequent mechanism of injury (59%). The overall mortality among reported patients has declined from 36% before 1950 to 9% since 1970. The injury occurred within 2 cm of the carina in 76% of patients, and 43% occurred within the first 2 cm of the right main bronchus. The proximity of the injury to the carina had no detectable effect on mortality. Injuries on the right side were treated sooner but were associated with a higher mortality than left-sided injuries. No association was detected between delay in treatment and successful repair of the injury; ninety percent of patients undergoing treatment more than 1 year after injury were repaired successfully. This review of patients with blunt tracheobronchial injuries represents the largest cohort studied to date. These data suggest an ability to repair tracheobronchial injuries successfully many months after they occur. We are also able to assess the mortality associated with the location and side of injury, examine the time from injury until diagnosis and treatment, and evaluate treatment outcome.

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Tracheobronchial injury secondary to blunt chest trauma: diagnosis and management.

Brian Chen, Paul K. Chu (2002)

Tracheobronchial injury is an uncommon complication in blunt chest trauma. The typical clinical features include haemoptysis, dyspneoa, and air leak. Tracheobronchial injury occurs after high energy impact and is commonly associated with injuries of other vital organs. If tracheobronchial injury is undetected and left untreated, it may cause persistent air leak which can render ventilation difficult and inefficient. Diagnosis of tracheobronchial injury should be made and confirmed by flexible bronchoscopy. The essence of airway management is to bypass the lesion by means of endobronchial intubation to the healthy bronchus with a single-lumen or double-lumen endotracheal tube. Such manoeuvres can also facilitate surgical access if thoracotomy is indicated. Taking into account the size of the lesion and the resulting respiratory status, surgical reconstruction of the injured airway is often necessary. More severe injury may even require lobectomy or pneumonectomy. Late complications of untreated tracheobronchial injury include bronchial stenosis, recurrent pneumonia and bronchiectasis. Prompt diagnosis and treatment generally lead to good functional recovery.

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Traumatic injury to the trachea and bronchus.

Riyad Karmy-Jones, Douglas E Wood (2007)

Tracheobronchial injuries are relatively uncommon, often require a degree of clinical suspicion to make the diagnosis, and usually require immediate management. The primary initial goals are twofold: stabilize the airway and define the extent and location of injury. These are often facilitated by flexible bronchoscopy, in the hands of a surgeon capable of managing these injuries. Most penetrating injuries occur in the cervical area. Most blunt injuries occur in the distal trachea or right mainstem, and are best approached by a right posterolateral thoracotomy. Choice and timing of approach are dictated by the presence and severity of associated injuries. The mainstay of intraoperative management remains a single-lumen endotracheal tube. Most injuries can be repaired by simple techniques, using interrupted sutures, but some require complex reconstructive techniques. Follow-up to detect stenosis or anastomotic technique is important, as is attention to pulmonary toilet.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Crit Illn Inj Sci

Journal ID (iso-abbrev): Int J Crit Illn Inj Sci

Journal ID (publisher-id): IJCIIS

Title: International Journal of Critical Illness and Injury Science

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2229-5151

ISSN (Electronic): 2231-5004

Publication date (Print): Apr-Jun 2015

Volume: 5

Issue: 2

Pages: 116-118

Affiliations

[1]Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran

Author notes

Address for correspondence: Dr. Nariman Sepehrvand, Canadian VIGOUR Centre, 2-132 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta - T6G 2E1, Canada. E-mail: nariman256@ 123456gmail.com

Article

Publisher ID: IJCIIS-5-116

DOI: 10.4103/2229-5151.158417

PMC ID: 4477389

SO-VID: 0705622a-9ef4-42f5-9612-4f7c5cf61ed9

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Tracheobronchial injury due to blunt chest trauma

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Preventive and Emergency Medicine Insights

Most cited references 18

Blunt tracheobronchial injuries: treatment and outcomes.

Tracheobronchial injury secondary to blunt chest trauma: diagnosis and management.

Traumatic injury to the trachea and bronchus.

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