Tracheal Injury(Archived)

Excerpt

The trachea is a tube-like structure beginning at the base of the cricoid cartilage and extending to the carina. It has cervical and thoracic portions, separated at the level of the thoracic inlet above and below respectively. It includes 18 to 22 D-shaped rings which are cartilaginous anteriorly and laterally and membranous posteriorly. Blood supply to the cervical portions of the trachea comes from branches of the subclavian artery where they enter laterally and anastomose superiorly, inferiorly, and anteriorly. Thoracic portions receive their blood supply from the bronchial arteries which branch off the aorta. The trachea is near the esophagus, vagus nerve, recurrent laryngeal nerves, thyroid, carotid arteries, jugular veins, innominate arteries and veins, the pulmonary trunk, the azygos vein, and the aorta with the vertebra and spinal cord posteriorly.

With so many vital structures adjacent to the trachea, the majority of patients with tracheal injuries may expire before arrival at an emergency department. The major causes of tracheal injury include iatrogenic, blunt trauma, penetrating trauma, inhalation and aspiration of liquids or objects. The most common site for tracheal injuries from blunt trauma is within 2.5 cm of the carina. Tracheal lacerations can be transverse, spiral, or longitudinal with varying degrees of tissue involvement.

One of the most crucial factors for reducing morbidity and mortality is early detection. With a high index of suspicion, the physical and radiographic signs most frequently seen with tracheal injury were dyspnea, pneumomediastinum, pneumothorax, and subcutaneous emphysema. Proper airway management is vital. When appropriate, it is best achieved by awake intubation over a flexible bronchoscope with the placement of an endotracheal tube distal to the site of injury. Management of laceration repair can then be accomplished either conservatively or surgically depending on the cause of the injury, the depth, and the concomitant injuries sustained. Despite early recognition and appropriate management, potential complications include; decreased lung function, infection, vocal cord paralysis, and strictures.