Successful conservative management in iatrogenic tracheobronchial injury

Abstract

Background: The aim of this study was to describe and to assess the effectiveness of conservative treatment as the chosen treatment for managing iatrogenic tracheobronchial injuries (ITBI).

Methods: Between January 1993 and December 2003, 33 tracheobronchial injuries were treated in our hospital. Eighteen (54.5%) were ITBI and 15 (45.5%) were traumatic noniatrogenic injuries. Of the ITBI patients, sex distribution was 15 (83%) females and 3 (17%) males with a mean age of 57.7 +/- 20.7 years (range, 17 to 88 years). Fifteen (83.3%) of the injuries were caused by orotracheal intubation and 3 (15.7%) by tracheotomy. The average diagnostic delay was 25.7 +/- 22.9 hours. The mean injury size was 2.83 +/- 1.02 cm (range, 1 to 4 cm). Nine (50%) injuries were located in the cervical trachea, 6 (33.3%) in the thoracic trachea, and 3 (16%) involved both trachea and main bronchi. Conservative treatment was chosen for 17 (94.4%) of the 18 cases. We performed surgical repair in only 1 case owing to progressive subcutaneous emphysema and increasing difficulty with mechanical ventilation.

Results: No complications arose from the use of conservative treatment. Four patients (22%) died in our hospital, 3 of these of non-ITBI-related causes. Mortality was not related to four variables: sex, diagnostic delay, location, or size of the ITBI. Fourteen of the 18 patients (77.7%) were discharged uneventfully, and the endoscopic and clinical follow-up examinations were satisfactory in all patients.

Conclusions: Conservative treatment for ITBI is effective regardless of production, size, or site of the injuries. Surgical treatment is advisable in specific cases: rapid progression of subcutaneous and mediastinal emphysema, mediastinitis, and difficulty with mechanical ventilation.