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

diagnosis.
Cassada DC - Ann Thorac Surg - 01-May-2000; 69(5): 1563-7
From NIH/NLM MEDLINE
NLM Citation ID:
10881842 (PubMed}
20337690 (MEDLINE)
Full Source Title:
Annals of Thoracic Surgery
Publication Type:
Journal Article
Language:
English
Author Affiliation:
Department of Surgery, The University of Tennessee Medical Center at Knoxville, 37920, USA.
Authors:
Cassada DC; Munyikwa MP; Moniz MP; Dieter RA Jr; Schuchmann GF; Enderson BL
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.
Major Subjects:
 Bronchi / * injuries / surgery
 Trachea / * injuries / surgery
Additional Subjects:
 Adolescence
 Adult
 Child
 Debridement
 Female
 Human
 Length of Stay
 Male
 Middle Age
 Wounds and Injuries / diagnosis / mortality
 Wounds, Nonpenetrating / diagnosis / surgery
 Wounds, Penetrating / diagnosis / surgery
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