Acute injuries of the trachea and major bronchi: importance of early diagnosis

Background. Tracheobronchial injuries are encountered with increasing frequency because of improvements in prehospital care and early initiation of the Advanced Trauma Life Support protocol. We review our experience with these injuries with the hypothesis that the leading determinant of patient outc...

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Published in:	The Annals of thoracic surgery Vol. 69; no. 5; pp. 1563 - 1567
Main Authors:	Cassada, David C, Munyikwa, Mudiwa P, Moniz, Mark P, Dieter, Raymond A, Schuchmann, George F, Enderson, Blaine L
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-05-2000 Elsevier Science
Subjects:	Adolescent Adult Biological and medical sciences Bronchi - injuries Bronchi - surgery Child Debridement Female Humans Length of Stay Male Medical sciences Middle Aged Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the respiratory system Trachea - injuries Trachea - surgery Wounds and Injuries - diagnosis Wounds and Injuries - mortality Wounds, Nonpenetrating - diagnosis Wounds, Nonpenetrating - surgery Wounds, Penetrating - diagnosis Wounds, Penetrating - surgery Human Diseases of the trachea Prognosis Respiratory disease Treatment efficiency Mortality Tracheobronchial Exploration Trauma Treatment Surgery Bronchus disease Diagnosis Lesion
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Summary:	Background. Tracheobronchial injuries are encountered with increasing frequency because of improvements in prehospital care and early initiation of the Advanced Trauma Life Support protocol. We review our experience with these injuries with the hypothesis that the leading determinant of patient outcome is the time interval to diagnosis. Methods. Patients with tracheobronchial injury were identified from the registry of our level 1 trauma center during a 10-year period ending December 1997. Clinical presentation, diagnostic evaluation, surgical management, and outcome were reviewed. Results. Twenty patients with ten cervical tracheal injuries and ten intrathoracic tracheobronchial injuries were treated. The mechanism of injury involved blunt trauma in 11 and penetrating trauma in 9. All patients underwent surgical debridement and primary repair. Patients with isolated airway injuries were discharged home after a mean hospital stay of 6 days and had no early complications. Three patients had delayed diagnosis (> 24 hours), and all sustained complications including death (1 patient) and multiorgan system failure (2 patients). The overall mortality rate was 15%. Conclusions. Operative management of tracheobronchial injuries can be achieved with acceptable mortality. Independent of mechanism or anatomic location of injury, delay in diagnosis is the single most important factor influencing outcome. Early recognition of tracheobronchial injury and expedient institution of appropriate surgical intervention are essential in these potentially lethal injuries.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0003-4975 1552-6259
DOI:	10.1016/S0003-4975(00)01077-8