Abstract
Introduction: Iatrogenic tracheal rupture is a rare potentially life-threatening lesion. The best treatment has still not been determined in the case of mechanically ventilated patients for whom surgery has a high mortality rate. The aim of this study is to assess the role of conservative management in patients with iatrogenic posterior tracheal wall perforation and to verify its role in critically ill mechanically ventilated patients. Methods: We reviewed the cases occurred at our hospital: a retrospective study was performed and 7 patients over a four-year period were identified. Conservative treatment consisted in endoscopic evaluation of tracheal tear healing and O2 therapy when dealing with spontaneous breathing patients with none or few symptoms without progression. When symptoms progressed and spontaneous ventilation wasn’t possible, patients underwent tracheal intubation or tracheostomy tube replacement and inflation of the cuff distal to the tear. This conduct has been chosen in membranous trachea injuries, independent of the injury size, diagnostic delay, or cause. Results: Conservative therapy was attempted in 5 over 7 cases, it was successful in all 5 cases without complications. No clinically evident mediastinitis or postoperative tracheobronchial stenosis was observed on endoscopic follow up. Conclusion: Our retrospective analysis showed that nonsurgical treatment could be a safe and suitable solution to achieve tracheal healing secondary to membranous injury. In cases where mechanical ventilation is needed, bridging the tear with the tracheal tube seems to give good results. Surgical treatment is advisable in cases of mediastinitis, progression of emphysema and difficulty in bridging the defect with an artificial airway. In the lack of randomized clinical trials comparing surgical and conservative treatments we reviewed our cases and created the ConservAtive vs surgery registry of tracheal ruPTUREs (CAPTURE registry) to collect data from different centers to provide clinicians with further evidences.
Highlights
Iatrogenic tracheal rupture is a rare potentially life-threatening lesion
Three patients presented with class I obesity, defined as a mean body mass index (BMI) between 30 and 34.9; all these patients were female
This hypothesis is based upon observations that iatrogenic lesions usually present themselves as longitudinal tears of the posterior tracheal wall, and that tissue healing is usually simpler and with a better prognosis when compared with other etiology lesions
Summary
Iatrogenic tracheal rupture is a rare potentially life-threatening lesion. The best treatment has still not been determined in the case of mechanically ventilated patients for whom surgery has a high mortality rate.The aim of this study is to assess the role of conservative management in patients with iatrogenic posterior tracheal wall perforation and to verify its role in critically ill mechanically ventilated patients. Iatrogenic tracheal rupture is a rare potentially life-threatening lesion. The best treatment has still not been determined in the case of mechanically ventilated patients for whom surgery has a high mortality rate. The aim of this study is to assess the role of conservative management in patients with iatrogenic posterior tracheal wall perforation and to verify its role in critically ill mechanically ventilated patients. Iatrogenic Tracheobronchial Rupture (ITBR) is distinct from noniatrogenic cause of tracheobronchial trauma and often implies a difficult and multidisciplinar management. Surgery has been considered the therapeutic gold standard for long time [4] but nowadays a deep change has occurred for therapeutic approach to this kind of lesions with the evidence of the effectiveness of conservative treatment [5]
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