Emergent Flexible Bronchoscopy for the Evaluation of Acute Chest Trauma

Abstract

To determine the role of emergent flexible bronchoscopy (EFB) in the evaluation of acute chest trauma, we retrospectively reviewed the bronchoscopic reports of 30 consecutive patients. 26 male and 4 female, over a 3-year period. Twenty-two patients presented following blunt chest trauma and eight following penetrating injury. They all received EFB within the first 24 h of the trauma, 24 of them within 12 h of arrival. Eighteen patients (60%) had positive bronchoscopic findings: bleeding from a peripheral airway (four patients), mucus plugs or thick secretion (four), tracheal lacerations (three), bronchial transections (two), supraglottic tear (one), severe vocal cord synechiae (one), subglottic swelling (one), blood clot in the bronchus (one), and distortion of the bronchial mucosa (one). The physical and roentgen-ologic findings that indicated a high probability of positive bronchoscopic findings included open wound over chest, subcutaneous emphysema, decreased breathing sound, bilateral pneumothoraces, pneumomediastinum, and signs of tracheobronchial separation. Ten patients (33%) benefited from EFB by a contribution in early management based on the bronchoscopic findings, which consisted of emergency operation or relieving respiratory distress by suction of endobronchial blood clot or secretion. The cases that most benefited from bronchoscopy were the ones that underwent EFB within 12 h after arrival. There was no bronchoscopy-related morbidity or mortality. We conclude that while EFB is valuable in selected patients with acute blunt and penetrating chest trauma, no combination of physical findings and roentgenologic findings is able to satisfactorily predict which patients will benefit.