Urgent surgical repair is pivotal in the management of major airway injury due to blunt trauma

Hysam Abdelmohty,Basem M Abdelgawad,Mohamed A Elanwar

doi:10.1186/s43057-020-00031-2

Hysam Abdelmohty, Basem M Abdelgawad + Show 1 more

Open Access

https://doi.org/10.1186/s43057-020-00031-2

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Abstract

BackgroundBlunt traumatic airway injury is a life-threatening injury in which urgent management is pivotal and this would come through improving our clinical management and diagnostic tools. Our objective was to emphasize the importance of early referral and urgent surgical repair of major airway injury.ResultsRecords of 42 patients with major airway injury out of 17,520 registered thoracic trauma cases were reviewed over the past 15 years. Twenty-eight cases documented to have major tracheobronchial injuries due to blunt trauma underwent surgical repair either urgent (21 cases) or late (7 cases). The age ranged from 8 to 43 years old with a mean age of 22.3 ± 0.8. The most common presenting symptom was shortness of breath in 22 (78.6%) cases and the most frequent sign was subcutaneous emphysema which was seen in 22 (78.6%) cases. The postoperative morbidity and mortality rates were significantly higher in the delayed repair group (p value < 0.001).ConclusionThe urgent surgical repair is the treatment of choice for major airway injury which is facilitated by early recognition and referral. It is pivotal to avoid respiratory and systemic complications and related mortality.

Highlights

Blunt traumatic airway injury is a life-threatening injury in which urgent management is pivotal and this would come through improving our clinical management and diagnostic tools
We have excluded injuries caused by penetrating trauma like stab wounds and those caused by iatrogenic trauma such as rigid bronchoscope injuries. This decision was based on the higher trauma severity and multiple associated injuries accounting for the higher mortality in blunt trauma group compared to penetrating or iatrogenic groups making the results biased if the latter two groups were included in the study
Forty-two out of 17,520 registered thoracic trauma patients (0.24%) reported having major airway injuries. Among those 42 patients, blunt trauma was the cause of injury in 31 (73.8%) patients, while seven (16.6%) injuries were due to iatrogenic causes, and only four (9.52%) penetrating injuries

Summary

Introduction

Blunt traumatic airway injury is a life-threatening injury in which urgent management is pivotal and this would come through improving our clinical management and diagnostic tools. Our objective was to emphasize the importance of early referral and urgent surgical repair of major airway injury. Acute posttraumatic tracheobronchial injuries (TBI) are rare but potentially life-threatening events. It is responsible for nearly 30% of deaths at the scene [1]. Rapid diagnosis and management are essential together with the proper assessment of associated injuries to set up the priorities in the ladder of management. Urgent surgical management of airway injuries prevents both early and late sequelae such as mediastinitis, airway stenosis, lobe collapse, and empyema.

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