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Diagnostic and therapeutic approach to post-traumatic tracheobronchial injuries

  • Angelo Carretta1,2
  • Paola Ciriaco1
  • Alessandro Bandiera1
  • Giampiero Negri1,2

1Department of Thoracic Surgery, San Raffaele Scientific Institute, 60 - 20132 Milan, Italy

2School of Medicine, Vita-salute San Raffaele University, 60 - 20132 Milan, Italy

DOI: 10.22514/sv.2021.015 Vol.17,Issue 2,March 2021 pp.10-19

Published: 08 March 2021

*Corresponding Author(s): Angelo Carretta E-mail: angelo.carretta@hsr.it

Abstract

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.


Keywords

Airway; Trauma; Surgery; Anesthesia; Conservative


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Angelo Carretta,Paola Ciriaco,Alessandro Bandiera,Giampiero Negri. Diagnostic and therapeutic approach to post-traumatic tracheobronchial injuries. Signa Vitae. 2021. 17(2);10-19.

References

[1] Cassada DC, Munyikwa MP, Moniz MP, Dieter RA Jr, Schuchmann GF, Enderson BL. Acute injuries of the trachea and main bronchi: importance of early diagnosis. The Annals of Thoracic Surgery. 2000; 69: 1563-1567.

[2] Minard G, Kudsk KA, Croce MA, Butts JA, Cicala RS, Fabian TC. Laryngotracheal trauma. The American Surgeon. 1992; 58: 181-187.

[3] Kummer C, Netto FS, Rizoli S, Yee D. A review of traumatic airway injuries: potential implications for airway assessment and management. Injury. 2007; 38: 27-33.

[4] Bertelsen S, Howitz P. Injuries of the trachea and bronchi. Thorax. 1972; 27: 188-194.

[5] Schneider T, Volz K, Dienemann H, Hoffmann H. Incidence and treatment modalities of tracheobronchial injuries in Germany. Interactive CardioVascular and Thoracic Surgery. 2009; 8: 571-576.

[6] Baumgartner F, Sheppard B, de Virgilio C, Esrig B, Harrier D, Nelson RJ, et al. Tracheal and main bronchial disruptions after blunt chest trauma: presentation and management. The Annals of Thoracic Surgery. 1990; 50: 569-574.

[7] Rossbach MM, Johnson SB, Gomez MA, Sako EY, Miller OL, Calhoon JH. Management of major tracheobronchial injuries: a 28-year experience. The Annals of Thoracic Surgery. 1998; 65: 182-186.

[8] Gómez-Caro A, Ausín P, Moradiellos FJ, Díaz-Hellín V, Larrú E, Pérez JA, et al. Role of conservative medical management of tracheobronchial injuries. The Journal of Trauma. 2006; 61: 1426-1434.

[9] Chu CPW, Chen PP. Tracheobronchial injury secondary to blunt chest trauma: diagnosis and management. Anaesthesia and Intensive Care. 2002; 30: 145-152.

[10] Wu M, Tsai Y, Lin M, Hsu I, Fong Y. Complete laryngotracheal disruption caused by blunt injury. The Annals of Thoracic Surgery. 2004; 77: 1211-1215.

[11] Norwood SH, McAuley CE, Vallina VL, Berne JD, Moore WL. Complete cervical tracheal transection from blunt trauma. The Journal of Trauma. 2001; 51: 568-571.

[12] Kiser AC, O’Brien SM, Detterbeck FC. Blunt tracheobronchial injuries: treatment and outcomes. The Annals of Thoracic Surgery. 2001; 71: 2059-2065.

[13] Kirsh MM, Orringer MB, Behrendt DM, Sloan H. Management of tracheobronchial disruption secondary to nonpenetrating trauma. The Annals of Thoracic Surgery. 1976; 22: 93-101.

[14] Balci AE, Eren N, Eren S, Ulkü R. Surgical treatment of post-traumatic tracheobronchial injuries: 14-year experience. European Journal of Cardio-Thoracic Surgery. 2002; 22: 984-989.

[15] Lyons JD, Feliciano DV, Wyrzykowski AD, Rozycki GS. Modern management of penetrating tracheal injuries. The American Surgeon. 2013; 79: 188-193.

[16] Miñambres E, Burón J, Ballesteros MA, Llorca J, Muñoz P, González-Castro A. Tracheal rupture after endotracheal intubation: a literature systematic review. European Journal of Cardio-Thoracic Surgery. 2009; 35: 1056-1062.

[17] Ceylan KC, Kaya SO, Samancilar O, Usluer O, Gursoy S, Ucvet A. Intraoperative management of tracheobronchial rupture after double-lumen tube intubation. Surgery Today. 2013; 43: 757-762.

[18] Massard G, Rougé C, Dabbagh A, Kessler R, Hentz JG, Roeslin N, et al. Tracheobronchial lacerations after intubation and tracheostomy. The Annals of Thoracic Surgery. 1996; 61: 1483-1487.

[19] Warner MA, Fox JF. Direct laryngoscopy and endotracheal intubation complicated by anterior tracheal laceration secondary to protrusion of preloaded endotracheal tube stylet. Case Reports. 2016; 6: 77-79.

[20] Marty-Ané CH, Picard E, Jonquet O, Mary H. Membranous tracheal rupture after endotracheal intubation. The Annals of Thoracic Surgery. 1995; 60: 1367-1371.

[21] Grewal HS, Dangayach NS, Ahmad U, Ghosh S, Gildea T, Mehta AC. Treatment of tracheobronchial injuries. Chest. 2019; 155: 595-604.

[22] Symbas PN, Justicz AG, Ricketts RR. Rupture of the airways from blunt trauma: treatment of complex injuries. The Annals of Thoracic Surgery. 1992; 54: 177-183.

[23] Gosnell JE, Campbell P, Sidhu S, Sywak M, Reeve TS, Delbridge LW. Inadvertent tracheal perforation during thyroidectomy. The British Journal of Surgery. 2006; 93: 55-56.

[24] Lui N, Wright C. Intraoperative tracheal injury. Thoracic Surgery Clinics. 2016; 25: 249-254.

[25] Kim JH, Shin JH, Song H, Shim TS, Ko G, Yoon H, et al. Tracheobronchial laceration after balloon dilation for benign strictures: incidence and clinical significance. Chest. 2007; 131: 1114-1117.

[26] Cosgrove JE, Sweenie A, Raftery G, Carey SM, Kilner AJ, Nesbitt ID, et al. Locally developed guidelines reduce immediate complications from percutaneous dilatational tracheostomy using the Ciaglia Blue Rhino technique: a report on 200 procedures. Anaesthesia and Intensive Care. 2006; 34: 782-786.

[27] Trottier SJ, Hazard PB, Sakabu SA, Levine JH, Troop BR, Thompson JA, et al. Posterior tracheal wall perforation during percutaneous dilational tracheostomy: an investigation into its mechanism and prevention. Chest. 1999; 115: 1383-1389.

[28] Winkler WB, Karnik R, Seelmann O, Havlicek J, Slany J. Bedside per-cutaneous dilational tracheostomy with endoscopic guidance: experience with 71 ICU patients. Intensive Care Medicine. 1994; 20: 476-479.

[29] Maxwell BG, Ganaway T, Lighthall GK. Percutaneous tracheostomy at the bedside: 13 tips for improving safety and success. Journal of Intensive Care Medicine. 2014; 29: 110-115.

[30] Dennis BM, Eckert MJ, Gunter OL, Morris JA, May AK. Safety of bedside percutaneous tracheostomy in the critically ill: evaluation of more than 3,000 procedures. Journal of the American College of Surgeons. 2013; 216: 858-857.

[31] Bagga B, Kumar A, Chahal A, Gamanagatti S, Kumar S. Traumatic airway injuries: role of imaging. Current Problems in Diagnostic Radiology. 2020; 49: 48-53.

[32] Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Academic Emergency Medicine. 2010; 17: 11-17.

[33] Savaş R, Alper H. Fallen lung sign: radiographic findings. Diagnostic and Interventional Radiology. 2008; 14: 120-121.

[34] Chen JD, Shanmuganathan K, Mirvis SE, Killeen KL, Dutton RP. Using CT to diagnose tracheal rupture. American Journal of Roentgenology. 2001; 176: 1273-1280.

[35] Barnhart GR, Brooks JW, Kellum JM. Pneumoperitoneum resulting from tracheal rupture following blunt chest trauma. The Journal of Trauma. 1986; 26: 486-488.

[36] Koletsis E, Prokakis C, Baltayiannis N, Apostolakis E, Chatzimichalis A, Dougenis D. Surgical decision making in tracheobronchial injuries on the basis of clinical evidences and the injury’s anatomical setting: a retrospective analysis. Injury. 2012; 43: 1437-1441.

[37] Verschueren DS, Bell RB, Bagheri SC, Dierks EJ, Potter BE. Man-agement of laryngo-tracheal injuries associated with craniomaxillofacial injuries. Journal of Oral and Maxillofacial Surgery. 2006; 64: 203-214.

[38] Bonanno FG. Issues of critical airway management (which anesthesia; which surgical airway?). Journal of Emergencies, Trauma, and Shock. 2012; 5: 279-284.

[39] Ono Y, Yokoyama H, Matsumoto A, Kumada Y, Shinohara K, Tase C. Surgical airways for trauma patients in an emergency surgical setting: 11 years’ experience at a teaching hospital in Japan. Journal of Anesthesia. 2013; 27: 832-837.

[40] Naghibi K, Hashemi L, Sajedi P. Anesthetic management of tracheo-bronchial rupture following blunt chest trauma. Acta Anaesthesiologica Scandinavica. 2003; 47: 901-903.

[41] Conti M, Pougeoise M, Wurtz A, Porte H, Fourrier F, Ramon P, et al. Management of postintubation tracheobronchial ruptures. Chest. 2006; 130: 412-418.

[42] Carretta A, Ciriaco P, Bandiera A, Muriana P, Pappalardo F, Broman LM, et al. Veno-venous extracorporeal membrane oxygenation in the surgical management of post-traumatic intrathoracic tracheal transection. Journal of Thoracic Disease. 2018; 10: 7045-7051.

[43] Carbognani P, Bobbio A, Cattelani L, Internullo E, Caporale D, Rusca M. Management of postintubation membranous tracheal rupture. The Annals of Thoracic Surgery. 2004; 77: 406-409.

[44] Harris R, Joseph A. Acute tracheal rupture related to endotracheal intubation: case report. The Journal of Emergency Medicine. 2000; 18: 35-39.

[45] Ross HM, Grant FJ, Wilson RS, Burt ME. Nonoperative management of tracheal laceration during endotracheal intubation. The Annals of Thoracic Surgery. 1997; 63: 240-242.

[46] Cardillo G, Carbone L, Carleo F, Batzella S, Jacono RD, Lucantoni G, et al. Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non-surgical treatment. European Journal of Cardio-Thoracic Surgery. 2010; 37: 581-587.

[47] Herrmann D, Volmerig J, Al-Turki A, Braun M, Herrmann A, Ewig S, et al. Does less surgical trauma result in better outcome in management of iatrogenic tracheobronchial laceration? Journal of Thoracic Disease. 2019; 11: 4772-4781.

[48] Massard G, Whilm JM. Decompressing tracheostomy for the treatment of postintubation tracheal rupture. The Annals of Thoracic Surgery. 1999; 68: 1125-1126.

[49] Reed MF, Mathisen DJ. Tracheoesophageal fistula. Chest Surgery Clinics of North America. 2003; 13: 271-289.

[50] Cooper JD, Todd TR, Ilves R, Pearson FG. Use of silicone tracheal T tube for the management of complex tracheal injuries. The Journal of Thoracic and Cardiovascular Surgery. 1981; 82: 559-68.

[51] Carretta A, Melloni G, Bandiera A, Negri G, Voci C, Zannini P. Con-servative and surgical treatment of acute posttraumatic tracheobronchial injuries. World Journal of Surgery. 2011; 35: 2568-2574.

[52] Lampl L. Tracheobronchial injuries. Conservative treatment. Interactive Cardiovascular and Thoracic Surgery. 2004; 3: 401-405.

[53] Lee SK, Kim DH, Lee SK, Kim Y, Cho JS, I H. Does surgical repair still have a role for iatrogenic tracheobronchial rupture? Clinical analysis of a thoracic surgeon’s opinion. Annals of Thoracic and Cardiovascular Surgery. 2016; 22: 348-353.

[54] Tazi-Mezalek R, Musani AI, Laroumagne S, Astoul PJ, D’Journo XB, Thomas PA, et al. Airway stenting in the management of iatrogenic tracheal injuries: 10-year experience. Respirology. 2016; 21: 1452-1458.

[55] Lee BE, Korst RJ. Successful treatment of an iatrogenic tracheal laceration with a temporary polyurethane-coated nitinol stent. The Annals of Thoracic Surgery. 2016; 102: e11-e12.

[56] Mughal MM, Gildea TR, Murthy S, Pettersson G, DeCamp M, Mehta AC. Short-term deployment of self-expanding metallic stents facilitates healing of bronchial dehiscence. American Journal of Respiratory and Critical Care Medicine. 2005; 172: 768-771.

[57] Shemmeri E, Vallières E. Blunt tracheobronchial trauma. Thoracic Surgery Clinics. 2018; 28: 429-434.

[58] Yamamoto S, Endo S, Endo T, Mitsuda S. Successful silicon stent for life-threatening tracheal wall laceration. Annals of Thoracic and Cardiovascular Surgery. 2013; 19: 49-51.

[59] Welter S, Krbek T, Halder R, Stamatis G. A new technique for complete intraluminal repair of iatrogenic posterior tracheal lacerations. Interactive CardioVascular and Thoracic Surgery. 2011; 12: 6-9.

[60] Krassas A, Mallios D, Iliadis I, Agiannidou A, Boulia S, Iliadis K. Bronchoscopical repair of tracheal laceration using conventional instrumentation: a novel technique. The Annals of Thoracic Surgery. 2020; 109: e141-e143.

[61] Angelillo-Mackinlay T. Transcervical repair of distal membranous tracheal laceration. The Annals of Thoracic Surgery. 1995; 59: 531-532.

[62] Lancelin C, Chapelier AR, Fadel E, Macchiarini P, Dartevelle PG. Transcervical-transtracheal endoluminal repair of membranous tracheal disruptions. The Annals of Thoracic Surgery. 2000; 70: 984-986.

[63] Sulek M, Miller RH, Mattox KL. The management of gunshot and stab injuries of the trachea. Archives of Otolaryngology. 1983; 109: 56-59.

[64] Mathisen DJ, Grillo H. Laryngotracheal trauma. The Annals of Thoracic Surgery. 1987; 43: 254-262.

[65] Richardson JD. Outcome of tracheobronchial injuries: a long-term perspective. The Journal of Trauma. 2004; 56: 30-36.

[66] Leinung S, Möbius C, Hofmann H, Ott R, Rüffert H, Schuster E, et al. Iatrogenic tracheobronchial ruptures-treatment and outcomes. Interactive Cardiovascular and Thoracic Surgery. 2006; 5: 303-306.

[67] Grillo HC, Donahue DM, Mathisen DJ, Wain JC, Wright CD. Postintu-bation tracheal stenosis. Treatment and results. The Journal of Thoracic and Cardiovascular Surgery. 1995; 109: 486-483.

[68] Chitilian HV, Bao X, Mathisen DJ, Alfille PH. Anesthesia for airway surgery. Thoracic Surgery Clinics. 2018; 28: 249-255.

[69] Chang X, Zhang X, Li X, Xu M, Zhao H, Fang W, et al. Use of extracorporeal membrane oxygenation in tracheal surgery: a case series. Perfusion. 2014; 29: 159-162.

[70] Son BS, Cho WH, Kim CW, Cho HM, Kim SH, Lee SK, et al. Conservative extracorporeal membrane oxygenation treatment in a tracheal injury: a case report. Journal of Cardiothoracic Surgery. 2015; 10: 48.

[71] Sian K, McAllister B, Brady P. The use of extracorporeal membrane oxygenation therapy in the delayed surgical repair of a tracheal injury. The Annals of Thoracic Surgery. 2014; 97: 338-340.

[72] Hirsh J, Gollin G, Seashore J, Kopf G, Barash PG. Mediastinal “tamponade” of a tracheal rupture in which partial cardiopulmonary bypass was required for surgical repair. Journal of Cardiothoracic and Vascular Anesthesia. 1994; 8: 682-684.

[73] Pasic M, Ewert R, Engel M, Franz N, Bergs P, Kuppe H, et al. Aortic rupture and concomitant transection of the left bronchus after blunt chest trauma. Chest. 2000; 117: 1508-1510.

[74] Demir A, Olcmen A, Kara H, Dincer S. Delayed diagnosis of a complete bronchial rupture after blunt thoracic trauma. The Thoracic and Cardiovascular Surgeon. 2006; 54: 560-562.

[75] Glazer ES, Meyerson SL. Delayed presentation and treatment of tracheobronchial injuries due to blunt trauma. Journal of Surgical Education. 2008; 65: 302-308.

[76] Schneider T, Storz K, Dienemann H, Hoffmann H. Management of iatrogenic tracheobronchial injuries: a retrospective analysis of 29 cases. The Annals of Thoracic Surgery. 2007; 83: 1960-1964.




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