Tracheal and tracheobronchial tree injuries

Abstract

Although tracheobronchial injuries can be rapidly fatal, patients that survive the initial injury and reach definitive care have generally favorable outcomes. Penetrating trauma is the most common cause of this type of injury but it is seen with blunt trauma as well as during instrumentation of the airway. Signs of injury may include pain, hoarseness, stridor, hemoptysis, subcutaneous emphysema, and respiratory collapse. Mediastinal or intrapericardial air as well as pneumothorax may be seen on imaging. As in any trauma situation, evaluation and management of the airway takes priority. Definitive diagnosis can be made with computed tomography followed by bronchoscopy. Repairs should be done with absorbable suture in a tension-free fashion and should be buttressed with a vascularized pedicle of tissue when possible. Cervical tracheal injuries can be approached via collar incision and the majority of intra thoracic tracheobronchial injuries can be access through the right chest.