Original articles: General thoracic
Acute injuries of the trachea and major bronchi: importance of early diagnosis

https://doi.org/10.1016/S0003-4975(00)01077-8Get rights and content

Abstract

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.

Section snippets

Material and methods

Patients with TBI treated from January 1988 through December 1997 at The University of Tennessee Medical Center at Knoxville, a level 1 trauma center, were identified through the trauma registry. The prehospital, hospital, and autopsy records were reviewed for mechanism of injury, clinical presentation, associated injuries, radiographic and bronchoscopic findings, surgical management, and outcome. Outcome was evaluated in relation to potential risk factors including mechanism of injury,

Results

All injuries involved the upper airway between the cricoid cartilage and the secondary bronchial bifurcations. Of the 20 patients treated, 10 had cervical tracheal injuries, 9 had major bronchial lacerations, and 1 had intrathoracic tracheal injury. The mean age was 27 years (range, 8 to 45 years), and there were 14 male and 6 female patients (Table 1). Nineteen patients arrived from the scene of the incident, and 1 was transferred from another facility. Ten were transported to the trauma

Comment

Tracheobronchial injuries were thought to be universally fatal before Krinitzki [6] presented the case of a human long-term survivor in 1927. Twenty years later, Kinsella and Johnsrud [7] reported the first successful primary repair of a bronchial rupture caused by blunt trauma. Since then, several series 8, 9, 10 have demonstrated that early diagnosis and primary repair of these injuries lead to the least complications and the best long-term results.

The usual principles of trauma care apply to

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