Iatrogenic Tracheal Ruptures: Review of the Literature and Personal Experience on 11 Cases

Bülent Aydemir, Sezai Çelik, Oya Uncu, Handan Tanrıkulu, Tamer Okay

Department of Thoracic Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
Department of Thoracic Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey;.
Department of Thoracic Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey..

DOI: 10.4236/ojts.2013.34027                

Abstract

Objective: Iatrogenic tracheal rupture is a rare, but life-threatening complication of orotracheal intubation. In this retrospective study, etiology, and diagnostic and therapeutic approaches for iatrogenic tracheal ruptures were reviewed. Method: Eleven patients (6 males and 5 females) were diagnosed and treated for iatrogenic tracheal rupture in our clinic. The laceration occurred after orotracheal intubation in 7 cases, and during percutaneous tracheostomy and emergency tracheostomy in the other four cases, respectively. Diagnosis was made during thoracic surgery in 5 cases. The remaining cases were diagnosed in the post-operative period; the most common symptoms were mediastinal and subcutenous emphysema and pneumothorax. Results: The diagnosis was confirmed by bronchoscopy in all cases. The lacerations were longitudinal, 1-7 cm in length and were located in the distal membranous trachea. While ruptures detected intraoperatively were repaired during the surgery, the others were treated conservatively. No mortality was observed among cases treated surgically. However, three of the cases treated conservatively died (50%), and the cause of death was the underlying disease requiring intubation. Conclusion: We are in the opinion that primary disease is a determinant of patient outcome. Except cases identified during surgery, emergency surgical interventions should be preferred in patients, in whom ventilation cannot be achieved. On the other hand, bronchoscopic fibrin glue instillation should additively be applied to conservative treatment of tracheal lacerations.

Keywords

Tracheal Rupture; Iatrogenic; Surgery; Conservative Treatment

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	T. Schneider, K. Storz, H. Dienemann and H. Hoffmann, “Management of Iatrogenic Tracheobronchial Injuries: A Retrospective Analysis of 29 Cases,” Annals of Thoracic Surgery, Vol. 83, No. 6, 2007, pp. 1960-1964. http://dx.doi.org/10.1016/j.athoracsur.2007.01.042
[2]	P. Borasio, F. Ardissone and G. Chiampo, “Post-Intubation Tracheal Rupture. A Report on Ten Cases,” European Journal of Cardiothoracic Surgery, Vol. 12, No. 1, 1997, pp. 98-100. http://dx.doi.org/10.1016/S1010-7940(97)00111-5
[3]	H. Ishibashi, S. Ohta, M. Hirose and T. Akimoto, “Blunt Tracheal Transection and Long Tear in Posterior Membranous Trachea,” European Journal of Cardiothoracic Surgery, Vol. 30, No. 6, 2006, pp. 945-947. http://dx.doi.org/10.1016/j.ejcts.2006.09.009
[4]	P. Carbognani, A. Bobbio, L. Cattelani, E. Internullo, D. Caporale, et al., “Management of Postintubation Membranous Tracheal Rupture,” Annals of Thoracic Surgery, Vol. 77, No. 2, 2004, pp. 406-409. http://dx.doi.org/10.1016/S0003-4975(03)01344-4
[5]	E. Minambres, J. Burón, M. A. Ballesteros, J. Llorca, P. Munoz, et al., “Tracheal Rupture after endOtracheal Intubation: A Literature Systematic Review,” European Journal of Cardiothoracic Surgery, Vol. 35, No. 6, 2009, pp. 1056-1062. http://dx.doi.org/10.1016/j.ejcts.2009.01.053
[6]	S. Gabor, H. Renner, H. Pinter, O. Sankin, A. Maier, et al., “Indications for Surgery in Tracheobronchial Ruptures,” European Journal of Cardiothoracic Surgery, Vol. 20, No. 2, 2001, pp. 399-404. http://dx.doi.org/10.1016/S1010-7940(01)00798-9
[7]	A. Gómez-Caro, P. Ausín, F. J. Moradiellos, V. Díaz-Hellín, E. Larrú, et al., “Role of Conservative Medical Management of Tracheobronchial Injuries,” Journal of Trauma, Vol. 61, 2006, pp. 1426-1434. http://dx.doi.org/10.1097/01.ta.0000196801.52594.b5
[8]	L. Spaggiari, M. Rusca, P. Carbognani and P. Solli, “Tracheobronchial Laceration after Double-Lumen Intubation for Thoracic Procedures,” Annals of Thoracic Surgery, Vol. 65, No. 6, 1998, pp. 1837-1839.
[9]	H. S. Hofmann, G. Rettig, J. Radke, H. Neef and R. E. Silber, “Iatrogenic Ruptures of the Tracheobronchial Tree,” European Journal of Cardiothoracic Surgery, Vol. 21, No. 4, 2002, pp. 649-652. http://dx.doi.org/10.1016/S1010-7940(02)00037-4
[10]	E. Minambres, A. González-Castro, J. Burón, B. Suberviola, M. A. Ballesteros, et al., “Management of Postintubation Tracheobronchial Rupture: Our Experience and a Review of the Literature,” European Journal of Emergency Medicine, Vol. 14, No. 3, 2007, pp. 177-179. http://dx.doi.org/10.1097/MEJ.0b013e3280bef8f0
[11]	C. H. Marty-Ané, E. Picard, O. Jonquet and H. Mary, “Membranous Tracheal Rupture after Endotracheal Intubation,” Annals of Thoracic Surgery, Vol. 60, No. 5, 1995, pp. 1367-1371. http://dx.doi.org/10.1016/0003-4975(95)00643-Y
[12]	K. Gündüz and M. Yandi, “Isolated Tracheal Rupture Caused by Blunt Trauma and the Importance of Early Diagnosis: A Case Report,” European Journal of Emergency Medicine, Vol. 11, No. 4, 2004, pp. 217-219. http://dx.doi.org/10.1097/01.mej.0000114646.63700.ef
[13]	M. M. Rossbach, S. B. Johnson, M. A. Gomez, E. Y. Sako, et al., “Management of Major Tracheobronchial Injuries: A 28-Year Experience,” Annals of Thoracic Surgery, Vol. 65, No. 1, 1998, pp. 182-186. http://dx.doi.org/10.1016/S0003-4975(97)01001-1
[14]	A. Wurtz, L. Benhamed, I. Hysi and M. Conti, “Endoscopic or Conservative Management of Postintubation Tracheal Membrane Laceration,” Annals of Thoracic Surgery, Vol. 91, No. 5, 2011, pp. 1654-1655. http://dx.doi.org/10.1016/j.athoracsur.2010.11.044
[15]	J. D. Richardson, “Outcome of Tracheobronchial Injuries: A Long-Term Perspective,” Journal of Trauma, Vol. 56, No. 1, 2004, pp. 30-36. http://dx.doi.org/10.1097/01.TA.0000108631.72315.78
[16]	G. Frova and M. Sorbello, “Iatrogenic Tracheobronchial Ruptures: The Debate Continues,” Minerva Anestesiology, Vol. 77, No. 12, 2011, pp. 1130-1133.
[17]	D. H. Sierra, “Fibrin Sealent Adhesive Systems: A Review of Their Chemistry, Materiel Properties and Clinical Applications,” Journal of Biomaterials Application, Vol. 7, No. 4, 1993, pp. 309-352. http://dx.doi.org/10.1177/088532829300700402