Successful conservative management in iatrogenic tracheobronchial injury.

Abstract

BACKGROUND:

The aim of this study was to describe and to assess the effectiveness of conservative treatment as the chosen treatment for managing iatrogenic tracheobronchial injuries (ITBI).

METHODS:

Between January 1993 and December 2003, 33 tracheobronchial injuries were treated in our hospital. Eighteen (54.5%) were ITBI and 15 (45.5%) were traumatic noniatrogenic injuries. Of the ITBI patients, sex distribution was 15 (83%) females and 3 (17%) males with a mean age of 57.7 +/- 20.7 years (range, 17 to 88 years). Fifteen (83.3%) of the injuries were caused by orotracheal intubation and 3 (15.7%) by tracheotomy. The average diagnostic delay was 25.7 +/- 22.9 hours. The mean injury size was 2.83 +/- 1.02 cm (range, 1 to 4 cm). Nine (50%) injuries were located in the cervical trachea, 6 (33.3%) in the thoracic trachea, and 3 (16%) involved both trachea and main bronchi. Conservative treatment was chosen for 17 (94.4%) of the 18 cases. We performed surgical repair in only 1 case owing to progressive subcutaneous emphysema and increasing difficulty with mechanical ventilation.

RESULTS:

No complications arose from the use of conservative treatment. Four patients (22%) died in our hospital, 3 of these of non-ITBI-related causes. Mortality was not related to four variables: sex, diagnostic delay, location, or size of the ITBI. Fourteen of the 18 patients (77.7%) were discharged uneventfully, and the endoscopic and clinical follow-up examinations were satisfactory in all patients.

CONCLUSIONS:

Conservative treatment for ITBI is effective regardless of production, size, or site of the injuries. Surgical treatment is advisable in specific cases: rapid progression of subcutaneous and mediastinal emphysema, mediastinitis, and difficulty with mechanical ventilation.

• Authors: Abel Gómez-Caro Andrés, Francisco Javier Moradiellos Díez, Pilar Ausín Herrero, Vicente Díaz-Hellín Gude, Emilio Larrú Cabrero, Eduardo de Miguel Porch, José Luis Martín De Nicolás
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 79 Issue 6 Pg. 1872-8 (Jun 2005) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 15919275 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Iatrogenic Disease
• Intubation (adverse effects)
• Lung Injury
• Male
• Middle Aged
• Retrospective Studies
• Trachea (injuries)
• Treatment Outcome
• Wounds and Injuries (therapy)