Management of tracheobronchial injuries

Tracheobronchial injuries are rare but life threatening sequel of blunt chest trauma. Due to the difficult nature of these injuries and the demanding attributes of the involved surgery, the anesthesiologist faces tough challenges while securing the airway, controlling oxygenation, undertaking one-lung ventilation, maintaining anesthesia during tracheal reconstruction, and gaining adequate postoperative pain control. Amongst the few techniques that can be used with tracheobronchial injuries, cross field ventilation is a remotely described and rarely used technique, especially in injuries around the carina. We effectively applied cross field ventilation in both our cases and the outcome was excellent.

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Management of Blunt Pulmonary Injury

AACN Advanced Critical Care ◽

10.4037/nci.0000000000000059 ◽

2014 ◽

Vol 25 (4) ◽

pp. 375-386 ◽

Cited By ~ 1

Author(s):

John J. Gallagher

Keyword(s):

Lung Parenchyma ◽

Tracheobronchial Tree ◽

Pleural Space ◽

Pulmonary Contusion ◽

Initial Assessment ◽

Thoracic Injuries ◽

Airway Control ◽

Tracheobronchial Injuries ◽

Ventilation Strategies ◽

And Control

Thoracic injuries account for 25% of all civilian deaths. Blunt force injuries are a subset of thoracic injuries and include injuries of the tracheobronchial tree, pleural space, and lung parenchyma. Early identification of these injuries during initial assessment and resuscitation is essential to reduce associated morbidity and mortality rates. Management of airway injuries includes definitive airway control with identification and repair of tracheobronchial injuries. Management of pneumothorax and hemothorax includes pleural space drainage and control of ongoing hemorrhage, along with monitoring for complications such as empyema and chylothorax. Injuries of the lung parenchyma, such as pulmonary contusion, may require support of oxygenation and ventilation through both conventional and nonconventional mechanical ventilation strategies. General strategies to improve pulmonary function and gas exchange include balanced fluid resuscitation to targeted volume-based resuscitation end points, positioning therapy, and pain management.

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Traumatic tracheal and tracheobronchial injuries.

The Journal of the Japanese Association for Chest Surgery ◽

10.2995/jacsurg1987.5.415 ◽

1991 ◽

Vol 5 (4) ◽

pp. 415-419

Author(s):

Jun Shinada ◽

Hirokuni Yoshimura ◽

Saburo Hirai ◽

Kagehito Irisawa ◽

Akira Ishihara ◽

...

Keyword(s):

Tracheobronchial Injuries

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Tracheobronchial injuries: tertiary center experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319893822 ◽

2019 ◽

Vol 28 (1) ◽

pp. 22-28 ◽

Cited By ~ 1

Author(s):

Mohamed Elshabrawy Saleh ◽

Hatem Beshir ◽

Walid H Mohammed ◽

Mohammed Sanad

Keyword(s):

Pulmonary Resection ◽

Main Bronchus ◽

Right Thoracotomy ◽

Tertiary Center ◽

Tracheobronchial Injuries ◽

Level 3 ◽

Core Line ◽

Tracheobronchial Injury ◽

The Right ◽

Treatment Surgery

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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