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Review
. 2019 Mar;155(3):595-604.
doi: 10.1016/j.chest.2018.07.018. Epub 2018 Jul 27.

Treatment of Tracheobronchial Injuries: A Contemporary Review

Harpreet Singh Grewal  1 , Neha S Dangayach  2 , Usman Ahmad  3 , Subha Ghosh  4 , Thomas Gildea  1 , Atul C Mehta  5
Affiliations
Review

Treatment of Tracheobronchial Injuries: A Contemporary Review

Harpreet Singh Grewal et al. Chest. 2019 Mar.

Abstract

Tracheobronchial injury is a rare but a potentially high-impact event with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma and iatrogenic injury that might occur during surgery, endotracheal intubation, or bronchoscopy. Early recognition of clinical signs and symptoms can help risk-stratify patients and guide management. In recent years, there has been a paradigm shift in the management of tracheal injury towards minimally invasive modalities, such as endobronchial stent placement. Although there are still some definitive indications for surgery, selected patients who meet traditional surgical criteria as well as those patients who were deemed to be poor surgical candidates can now be managed successfully using minimally invasive techniques. This paradigm shift from surgical to nonsurgical management is promising and should be considered prior to making final management decisions.

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Figures

Figure 1
Figure 1
A and B, Example of endotracheal intubation-related airway injury with full-thickness posterior membranous tear (arrow) complicated by pneumomediastinum on a sagittal reformatted CT image (A), andsubcutaneous emphysema on an axial CT image (B).
Figure 2
Figure 2
Morphologic classification of tracheal injury as reported in Table 3. (Images designed by illustrator David Schumick. Image created at the Cleveland Clinic, Cleveland, OH.)
Figure 3
Figure 3
Example of level IIIA injury in a case of iatrogenic tracheal injury with full-thickness longitudinal tear in the trachea of the membranous portion (A, arrow) extending to just above the carina (B, arrow); mediastinal soft-tissue structures can be visualized (C, arrow) and treated with self-expanding metallic tracheal stent placement (D, arrow) with complete healing (E, arrow) after removal of the stent.
Figure 4
Figure 4
Algorithmic approach for contemporary treatment of tracheobronchial injuries. ECMO = extracorporeal membrane oxygenation; OR = operating room.
See this image and copyright information in PMC

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