Abstract
Tracheobronchial injuries are rare but potentially high-impact events with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma, often combined with various complex injuries, while iatrogenic injury usually occurs during operation, intubation, or bronchoscopy. An early and accurate diagnosis and a multidisciplinary approach in a center experienced in treating airway lesions are essential to obtain favorable results. For a long time, surgery has been considered the treatment of choice for post-traumatic airway lesions. However, recent reports have shown a paradigm shift in the management of tracheal injury towards a conservative approach, especially in treating iatrogenic lesions. In our experience of 11 consecutive patients, although there are still definitive indications for surgery, we demonstrated the effectiveness of conservative treatment in patients with mixed varieties of tracheal injury by etiology, extension, and complications.
Highlights
Tracheobronchial injuries (TBI) are potentially life-threatening clinical scenarios occurring after blunt and penetrating thoracic traumas or, more rarely, after iatrogenic procedures
We retrospectively reviewed the clinical records of 11 patients with tracheobronchial injuries between February 2015 and March 2021, diagnosed in our Division
No radiological evidence of mediastinitis on thoracic computed tomographic (CT) scan or progressive TBI signs and symptoms were noted in the following days
Summary
Tracheobronchial injuries (TBI) are potentially life-threatening clinical scenarios occurring after blunt and penetrating thoracic traumas or, more rarely, after iatrogenic procedures. The latters can occur during endotracheal intubations, surgery, endoscopic tracheobronchial procedures, or percutaneous tracheostomy [2]. About 0.005% of all intubations have a tracheal tear complication This incidence increases up to 0.19% in patients intubated with a double-lumen tube and up to 1% during percutaneous dilatational tracheostomy [4]. A conservative approach has been described in selected cases, it did not exceed the 50% in the reported series [6]. We describe the results of non-interventional conservative treatment in a consecutive series of selected TBI patients independently of etiology, location, or size of injury or diagnostic delay
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