Complete Tracheal Transection Research Articles

Post-Intubation Tracheoesophageal Fistula: Surgical Management by Complete Cervical Tracheal Transection.

We report successful surgical management of post-intubation tracheoesophageal fistula (TEF) in an adult patient requiring long-term mechanical ventilation. A complete tracheal transection without tracheal resection, via an anterior cervical approach, followed by direct closure of tracheal and esophageal defect, and interposition of muscle flap between the suture lines and tracheal reconstruction was performed. In selected cases, this surgical procedure may be a viable alternative to traditional techniques used to treat post-intubation TEF via the anterior or lateral cervical approach.

Delayed Diagnosis of Complete Tracheal Transection

Tracheal injuries are relatively rare; however, their mortality rate is relatively high. Complete disruption of the trachea is extremely rare, and a systematic approach is required for early diagnosis and favorable outcomes. This is a case report of a 17-year-old male admitted to the emergency room after a motor vehicle accident. He was agitated and in respiratory distress with labored breathing and urgently intubated orotracheally. In the first flexible bronchoscopy, the diagnosis of the tracheal transaction was missed. Due to saturation drop and high peak ventilator pressures on the seventh day, the flexible bronchoscopy examination was performed in the operating room. This measure revealed complete tracheal transection in midportion. Neck exploration demonstrated complete tracheal transection. The area was debrided, and primary end-to-end anastomosis was performed. The patient was extubated at the end of the surgery.

Delayed Diagnosis of Complete Tracheal Transection

Delayed Diagnosis of Complete Tracheal Transection

Complete Tracheal Transection Following Blunt Trauma: A Case Report and Review of Literature

Traumatic tracheobronchial injury is rare, but can be life-threatening. It is often associated with other fatal injuries. Early diagnosis and prompt treatment are crucial to produce the best outcome. We are reporting a 40-year-old gentleman, a lorry driver who had a head on collision with a car. He was brought to the casualty with an intact airway. ATLS was initiated and lead by trauma team. Subsequently in casualty, his conscious level dropped and he became distressed, hence a standard orotracheal intubation was performed. Following intubation, he developed massive subcutaneous emphysema to the neck and upper chest. Computed tomography (CT) showed tracheal injury at C7- T2 level, extensive subcutaneous emphysema, pneumomediastinum with malposition of the endotracheal tube. Emergency neck exploration was performed in operating theatre, and revealed a complete transection of trachea at the level of 2nd and 3rd tracheal ring. No other vital structures were injured. A tracheostomy was created, and the patient was managed in ICU for one day. Four days following the first surgery, he was transferred to a more specialized center for tracheal refashioning and anastomosis. The patient was discharged home later without a tracheostomy. In tracheobronchial injury, high level of suspicion based on clinical judgement is vital for prompt diagnosis, with adjunct of radiological investigation. Surgical intervention to establish a patent airway in operating theatre is undoubtedly crucial in a complete tracheal transection to prevent secondary insult from tissue hypoxia. In managing such injury, advance preparation should include setups for bronchoscopy and thoracotomy. Patient survival depends on preparation and prompt surgical intervention. A tailored surgical approach is often necessary for definitive repair.

Challenges in the Initial Management of Complete Tracheal Transection after Blunt Neck Trauma Blunt Complete Transection of Trachea

Challenges in the Initial Management of Complete Tracheal Transection after Blunt Neck Trauma Blunt Complete Transection of Trachea

Management of laryngotracheal trauma.

Laryngotracheal trauma is a rare but potentially life-threatening injury. It is usually seen in multiple-trauma patients and can go unrecognized and undertreated due to its scarcity. The presenting symptoms often do not correlate with the severity of the injury and injuries may range from an endolaryngeal hematoma to a complete tracheal transection. Accurate diagnosis of the extent of the injury can be achieved with a combination of high resolution computed tomography, flexible fiber optic laryngoscopy and flexible bronchoscopy. Treatment may include observation with symptomatic management, reduction and repair of laryngeal skeletal fractures, or complete tracheal or laryngeal reconstruction. Endolaryngeal stents are reserved for use in cases of significant mucosal trauma or injuries that disrupt the anterior commissure of the larynx. The most important goal in management is to first secure and reconstruct the airway. Once this has been achieved, the long-term goal of treatment is to restore the voice and swallowing mechanism.

Rare case of survivor after accidental hanging and complete tracheal transection

Rare case of survivor after accidental hanging and complete tracheal transection

Pediatric Blunt Neck Trauma Causing Esophageal and Complete Tracheal Transection

ABSTRACTBackground: Blunt injuries to the cervical trachea remain rare but present unique and challenging clinical scenarios for prehospital providers. These injuries depend on prehospital providers either definitively securing the injured airway or bridging the patient to a treatment facility that can mobilize the necessary resources. Case Summary: The case presented here involves a clothesline injury to a pediatric patient that resulted in complete tracheal transection and partial esophageal transection. Ground and air prehospital providers utilized a stepwise approach to this airway injury and achieved a favorable outcome. The patient was serendipitously intubated through a blind nasal approach that entered the proximal esophagus, exited through the tear and entered the distal trachea. Discussion: There is a paucity of literature describing the successful management of these devastating injuries. While some authors have advocated for early flexible fiberoptic intubation or proceeding directly to tracheostomy, these techniques are not available in the prehospital environment. This case also highlights the inherent issues with proceeding to cricothyroidotomy in patients with tracheal trauma and should give all providers pause before considering this management technique. Conclusion: Ultimately, a systematic approach to all airways will ensure that prehospital providers are best prepared for even the most challenging scenarios.

Complete Thoracic Tracheal Transection Caused by Blunt Trauma

Complete Thoracic Tracheal Transection Caused by Blunt Trauma

Delayed Diagnosis of Complete Tracheal Transection After Blunt Neck Trauma

The clinical features of tracheal injury include hoarseness, subcutaneous emphysema and edema, and bruising of the neck. Patients with tracheal injury may present with minimal signs that are easily overlooked. The priority in treating such patients is to appropriately identify the tracheal anatomy before further treatment is administered. In this case, a male patient aged 17 years was injured over the first tracheal ring while riding a motorcycle. His stable condition obscured pathognomonic signs of complete cervical tracheal transection, which caused an unnecessary delay in treatment. In a case such as ours, the application of high resolution computed tomography (CT), as an adjuvant to bronchoscopy is important. If tracheal transection is suspected, the proximal and distal ends of the trachea might be not on the same axis and traditional laryngoscopy should not be performed in haste. A CT virtual bronchoscopic evaluation can provide great accuracy when analyzing the central and segmental bronchi, and can prevent a delayed diagnosis of complete tracheal transection. If the diagnosis is still not definite, then diagnostic bronchoscopy and intubation at the operating room is recommended.

Anesthetic Management of a Patient with Complete Tracheal Transection by Blunt Trauma - A case report -

Tracheobronchial rupture due to blunt chest trauma is an uncommon injury and the clinical presentations are variable. Recently, the incidence of tracheobronchial injuries has increased with the increase in traffic accidents and mechanization. The early diagnosis and primary repair of tracheobronchial rupture not only restores normal lung function, but also avoids the difficulties and complications associated with delayed diagnosis and repair. We report our clinical experience in anesthetic management of a patient with complete tracheal transection suffering from progressive dyspnea, subcutaneous emphysema in the neck and anterior chest wall, and bilateral tension pneumothorax. The literature regarding accidental tracheal injuries will be reviewed. (Korean J Anesthesiol 2008; 54: 454∼8)

Prehospital fiberoptic intubation

We present a case of a patient with severe multiple trauma who was treated at the scene by a physician-staffed trauma life support team. Due to a complete tracheal transection, a "cannot ventilate, cannot intubate"-situation occurred. The patient was then intubated using a fiberoptic bronchoscope in the prehospital setting. The current literature concerning fiberoptic intubation in emergencies is discussed.

Anesthetic Management of Complete Tracheal Transection using Percutaneous Cardiopulmonary Support System - A case report -

Patients with complete tracheal transection present a considerable challenge to the anesthesiologist. A 38 year-old woman with complete tracheal transection above the aortic arch level due to blunt trauma was taken to the operating room for an attempt at tracheal repair. Anesthetic management was focused on the maintenance of the airway and adequate ventilation. Primary repair of the trachea was carried out under ventilation support via percutaneous cardiopulmonary support system. Until the disrupted trachea was exposed on the surgical field, ventilation was performed using a laryngeal mask. We discuss the anesthetic management strategies and the alternative mode of ventilation.

Blunt tracheal transection and long tear in posterior membranous trachea

Blunt tracheobronchial injuries are rare, but can be life-threatening. A precise preoperative diagnosis and a well-recognised plan of surgical treatment, which may be unique for each patient, are needed to restore the continuity of tracheobronchial tree in a one-stage intervention. We encountered a patient with complete tracheal transection and 15 cm tear in the posterior membranous trachea and right bronchus, and whose tracheal injury was difficult to repair using direct intubation of distal airway by bronchoscopy. We achieved a good result of one-stage repair using a percutaneous cardiopulmonary support (PCPS).

Management of acute complete tracheal transection caused by nonpenetrating trauma: Report of a case and review of the literature

Management of acute complete tracheal transection caused by nonpenetrating trauma: Report of a case and review of the literature

胸部打撲による閉鎖性頚部気管断裂例

A case of cervical tracheal injury secondary to blunt trauma to the chest is reported. A 36-year-old male visited our hospital complaining of dyspnea and hemoptysis after having been run over on the back of the chest. Physical examination revealed no sign of trauma (wound nor subdermal hematoma) on the surface of the neck but there was subcutaneous emphysema in the cervical and thoracic area. A chest X-ray and computed tomography revealed pneumomediastinum, right pneumothorax, subcutaneous and deep neck emphysema and a fracture of the right clavicle. After post oral in tubation and the insertion of a thoracostomy tube, fiberoptic bronchoscopy was performed, which showed a disruption of the trachea just beneath the sternal notch.The patient was immediately taken to an operation room. Complete tracheal transection at the level of sixth ring was revealed, and was subsequently reconstructed by means of end-to-end anastomosis. Bilateral recurrent nerves were also damaged, but they were not repaired. The postoperative course was uneventful. Tracheostomy was done on the 14th postoperative day and the patient, with a sealed tracheobutton, was discharged on the 47th day.In this case, the mechanism of cervical tracheal disruption was thought to be compression between the manubrium of the sternum and the vertebral column and the dramatic increase in intraairway pressure because the glottis was closed when the chest was crushed.

Anesthetic Review of Complete Tracheal Transection by Blunt Trauma: A case report

Anesthetic Review of Complete Tracheal Transection by Blunt Trauma: A case report

Fiberoptic Bronchoscopy in the Evaluation of Acute Chest and Upper Airway Trauma

To determine the utility of fiberoptic bronchoscopy (FFB) in the short-term evaluation of patients with trauma, we identified 53 consecutive patients (45 male patients; mean age, 36 years) seen over a ten-year period who had FFB performed within the first three days of trauma to the chest and upper airway. There were eight deaths. Fifty patients had blunt trauma to the chest. These were mostly due to motor vehicle accidents (38 patients), crushing injuries (three patients), and falls (three patients). In addition, there were three patients with trauma to the neck. Physical and radiographic findings included pneumothorax (37 patients), subcutaneous emphysema (31), pulmonary contusion (22), hemothorax (21), mediastinal emphysema (16), flail chest (ten), atelectasis (ten), and hemoptysis (five). The FFB was of diagnostic use in 28 patients (53 percent) by revealing complete tracheal transection (one patient), tracheal laceration (three), complete bronchial transection (one), bronchial laceration (two), bronchial contusion (two), ongoing distal hemorrhage/pulmonary contusion (seven), aspirated material (three), mucous plugging/thick secretions (eight), and supraglottic lesions (three). One of the cases of tracheal laceration was not fully appreciated as a complete transection. We conclude that FFB has value in the short-term evaluation of patients with trauma.

Contraction of dog trachealis muscle in vivo: role of alpha-adrenergic receptors.

Contraction, relaxation, and longitudinal tension were recorded by isometric strain gauge arches attached to cervical tracheal muscle (CTM) in 60 spontaneously breathing dogs anesthetized with pentobarbital. Intravenous norepinephrine (NE) (3 X 10(-9), 6 X 10(-9), 1.2 X 10(-8), and 2.4 x 10(-8) mol/kg) increased spontaneous mechanical activities (SMA) and caused dose related contraction of CTM in all dogs even though there was no pretreatment with beta-blockers. These activities were first potentiated by propranolol and then prevented by phentolamine. NE briefly decreased SMA and induced CTM relaxation prior to the onset of contraction in one-third of dogs. Propranolol prevented this initial relaxation. CTM responses induced by NE were 1) not significantly altered by atropine, tripelennamine, bilateral vagotomy, curarization, and complete tracheal transection below transducer sites; 2) unrelated to passive constriction of cervical trachea associated with airway elongation; and 3) independent of reflexes initiated by elevations of systemic arterial pressure. The moles per kilogram doses of acetylcholine were found to exceed those of NE when their intravenous administration caused equal CTM contractions in the same dog. These findings are consistent with the existence of alpha-adrenergic receptors in CTM.