Management of Tracheobronchial Injuries with Subcutaneous Emphysema

Background: Subcutaneous emphysema is infiltration of air under dermis layers in tracheobronchial injuries and needs to be immediately addressed for proper management. Aim: To assess the management protocols for tracheobronchial injuries with subcutaneous emphysema. Study design: Retrospective study. Place and duration of study: Dept of Thoracic Surgery, Sandeman Provincial Hospital Quetta from 01-01-2020 to 31-03-2021. Methodology: Fifty patients were assessing for their management techniques in tracheobronchial injuries with subcutaneous emphysema. Patients with conservative as well as surgical management were completely analyzed. Their data regarding traumatic injury was recorded. Results: The mean age of patients was 22.3±5.2 years with 85% being males and 15% females enrolled. Patients who had less traumatic injury and were managed by conservative treatment has better recovery rate than surgically operated cases. Conclusion: Timely management with surgical procedure in severe injuries is required for better recovery outcomes. Keywords: Tracheobronchial injury, Subcutaneous emphysema, Traumatic surgery

Conservative Treatment in Tracheobronchial Injuries—An Institutional Report

Tracheobronchial injuries are rare but potentially high-impact events with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma, often combined with various complex injuries, while iatrogenic injury usually occurs during operation, intubation, or bronchoscopy. An early and accurate diagnosis and a multidisciplinary approach in a center experienced in treating airway lesions are essential to obtain favorable results. For a long time, surgery has been considered the treatment of choice for post-traumatic airway lesions. However, recent reports have shown a paradigm shift in the management of tracheal injury towards a conservative approach, especially in treating iatrogenic lesions. In our experience of 11 consecutive patients, although there are still definitive indications for surgery, we demonstrated the effectiveness of conservative treatment in patients with mixed varieties of tracheal injury by etiology, extension, and complications.

Conservative Management of Large Traumatic Tracheal Laceration

Tracheobronchial injuries following blunt trauma have a low incidence due to the high mortality rate before reaching hospitals. This case report advocates for conservative management in a hemodynamic patient with a large longitudinal tracheal laceration with no signs of acute complication.

Diagnostic and therapeutic approach to post-traumatic tracheobronchial injuries

Post-traumatic tracheobronchial lesions are associated with high mortality unless adequately diagnosed and treated. They may be caused by blunt and penetrating trauma, although iatrogenic lesions are also increasingly observed. An early and accurate diagnosis significantly impacts the results of treatment. Radiological assessment with computed tomography is highly accurate, but bronchoscopy remains the gold standard technique in the diagnosis of airway trauma and plays an important role in determining the therapeutic approach. For a long time, surgery has been considered the treatment of choice for post-traumatic airway lesions, but recent reports have shown that favourable results may also be obtained with a conservative approach, especially in the treatment of iatrogenic lesions. The indication for a conservative or surgical treatment has to be defined on the basis of a thorough clinical, radiological, and endoscopic assessment. Specific issues concerning airway management in the emergency setting and during surgical treatment must also be addressed. A multidisciplinary approach in a center with specific experience in the treatment of airway lesions is of utmost importance to obtain favourable results.

Traumatic tracheobronchial injuries: incidence and outcome of 136.389 patients derived from the DGU traumaregister

To describe the incidence, therapy and outcome of traumatic tracheobronchial injuries (TTBI) in trauma patients with multiple injuries derived from the DGU TraumaRegister. We analyzed the data on all patients listed on the TraumaRegister DGU (TR-DGU) in Germany between 2002 and 2015 aged 16 years or older and with an Injury Severity Score (ISS) of ≥ 9. We analyzed the data on 136,389 trauma patients, 561 of whom had suffered tracheobronchial injuries (0.4%). The majority were male (73.4%) and had a mean age of 43.7 years. In total, 84.0% of all TTBI injuries occurred secondary to blunt trauma, caused mainly by accidents (71.2%). TTBI was accompanied by several concomitant thoracic injuries such as pneumo- (41.2%) and hemothorax (23.2%), lacerations (7.8%) and contusions (32.3%) of the lung, as well as multiple rib fractures (29.6%). The severity of injury was classified via the abbreviated injury scale (AIS): 39.3% with AIS = 3, 51.3% with AIS = 4 and 60% with AIS = 5 patients underwent surgical interventions. The mortality of patients with tracheobronchial injuries was higher: 24.6%, versus 13.7% in all patients (control group). This high percentage reflects their generally severe injury burden through concomitant injuries. The incidence of TTBI in this large cohort of trauma patients is very low. However, its high mortality rate emphasizes its importance. Mortality was associated with higher ISS and AIS scores. Higher rates of concomitant injuries were therefore associated with a higher mortality rate. TTBI injuries revealed a higher rate of progression to surgical management, with 35% undergoing surgery within the first 24 h. This excessive mortality rate demonstrates a high overall injury burden in patients with TTBI and high mortality of associated injuries. A surgical intervention’s impact on mortality cannot be assessed in this study, as it would need to be investigated in a case-matched study.

Urgent surgical repair is pivotal in the management of major airway injury due to blunt trauma

Background Blunt traumatic airway injury is a life-threatening injury in which urgent management is pivotal and this would come through improving our clinical management and diagnostic tools. Our objective was to emphasize the importance of early referral and urgent surgical repair of major airway injury. Results Records of 42 patients with major airway injury out of 17,520 registered thoracic trauma cases were reviewed over the past 15 years. Twenty-eight cases documented to have major tracheobronchial injuries due to blunt trauma underwent surgical repair either urgent (21 cases) or late (7 cases). The age ranged from 8 to 43 years old with a mean age of 22.3 ± 0.8. The most common presenting symptom was shortness of breath in 22 (78.6%) cases and the most frequent sign was subcutaneous emphysema which was seen in 22 (78.6%) cases. The postoperative morbidity and mortality rates were significantly higher in the delayed repair group (p value < 0.001). Conclusion The urgent surgical repair is the treatment of choice for major airway injury which is facilitated by early recognition and referral. It is pivotal to avoid respiratory and systemic complications and related mortality.