Tracheal rupture after endotracheal intubation

Česká verzia

Authors: J. Šafránek ¹; J. Klečka ¹; I. Chytra ²; P. Altmann ²; F. Brůha ³
Authors place of work: Chirurgická klinika FN v Plzni, přednosta: prof. MUDr. Vladislav Třeška, DrSc. ¹; Anesteziologickoresuscitační klinika FN v Plzni, Přednosta: doc. MUDr. Eduard Kasal, CSc. ²; Klinika TRN FN v Plzni, Přednosta: prof. MUDr. Miloš Pešek, CSc. ³
Published in the journal: Prakt. Lék. 2011; 91(4): 218-221
Category: Case Report

Summary

Iatrogenic tracheal rupture, most frequently in pars membranosa, is a rare tracheal complication. We present two cases from our Hospital that have occurred in the past 5 years.

The first case was of a 23 year-old female, intubated because of ileal surgery. Dyspnoea was rapid, and bilateral pneumothorax and subcutaneous emphysema developed. Surgical management was necessary. Via a right thoracotomy a suture was performed to the 35 mm lesion of the distal part of the trachea. Tracheal tube was left above suture line following the procedure. The patient was extubated on postoperative day 2. Following surgery, multiple bronchoscopy suction of the bronchial tree was necessary. The patient was discharged on postoperative day 26.

The second case was of a 79 year-old female, who had to under go emergency intubation at home by a paramedic because of acute exacerbation of Chronical Obstructive Lung Disease. Post extubation (same day), neck subcutaneous emphysema and CT pneumomediastinum were observed. Bronchoscopy confirmed a 30 mm lesion of the distal membranous part of the trachea. Through non-invasive ventilation, respiratory distress ceased and the patient‘s condition was stabilised. These and the patient’s advanced age were reasons for following a conservative treatment. A week after the injury, the patient was discharged home.

Surgical management is more preferable, and more certain, treatment method for tracheal rupture after intubation. Conservative treatment is feasible for patients in poor physical condition if there is no progression of dyspnoea or signs of mediastinitis.

Keywords:
tracheal rupture, intubation, surgery, conservative management.

Zdroje

1. Andrés, A.G-C., Díez, F.J.M., Herrero, P.A. et al. Successful Conservative Management in Iatrogenic Tracheobronchial Injury. Original Research Article. Annals of Thoracic Surgery 2005, 79, 6, p. 1872-1878.

2. Brosario, P., Ardissone, F., Chiampo, G. Post-intubation tracheal rupture. A case report on ten cases. Eur. J. Cardiothorac. Surg. 1997, 12, p. 98-100.

3. Carbognani, P., Bobbio, A., Cattelani, I. et al. Management of postintubation membranous tracheal rupture. Ann. Thorac. Surg. 2004,77, p. 406-409.

4. Gabor, S., Renner, H., Pinter, H. et al. Indications for surgery in tracheobronchial ruptures. Eur. J. Cardiothorac. Surg. 2001, 20, p. 399-404.

5. Hofmann, H.S., Rettig, G., Radke, J. et al. Iatrogenic ruptures of the tracheobronchial tree. Eur. J. Cardiothorac. Surg. 2002, 21, p. 649-652.

6. Chen, E.H., Logman, Z.M., Glass, P.S., Bilfinger, T.V. A case of tracheal injury after emergent endotracheal intubation: a review of the literature and causalities. Anesth. Analg. 2001, 93, p. 1270-1271.

7. Jougon, J., Ballester, M., Choukroun, E. et al. Conservative treatment for postintubation tracheobronchial rupture. Original Research Article. Annals of Thoracic Surgery 2000, 69, 1, p. 216-220.

8. Kaloud, H., Smolle-Juettner, F.M., Prause, G., List, W.F. Iatrogenic ruptures of the tracheobronchial tree. Chest 1997, 112, p. 774-778.

9. Leinung, S., Möbius, C., Hofmann, H-S.et al. Iatrogenic tracheobronchial ruptures - treatment and outcomes. Interactive CardioVascular and Thoracic Surgery, 2006, 5, p. 303-306.

10. Madden, B., Datta, S., Hussain, I., McAnulty, G. Tracheal stenting for rupture of the posterior wall of the trachea following percutaneous tracheostomy. Monaldi Arch. Chest. Dis. 2001, 56, p. 320-321.

11. Marty-Ané, C-H., Picard, E., Jonquet, O., Mary, H. Membranous tracheal rupture after endotracheal intubation. Original Research Article. Annals of Thoracic Surgery 1995, 60, 5, p. 1367-1371.

12. Massard, G., Rouge, C., Dabbagh, A. et al. Tracheobronchial lacerations after intubation and tracheostomy. Ann. Thorac. Surg. 1996, 61, p. 1483-1487.

13. Miñambres, E., Burón, J., Ballesteros, M.A. et al. Tracheal rupture after endotracheal intubation : a literature systematic review. Review Article. European Journal of Cardio-Thoracic Surgery 2009, 35, 6, p. 1056-1062.

14. Schneider, T., Storz, K., Dienemann, H. et al. Management of Iatrogenic Tracheobronchial Injuries: A Retrospective Analysis of 29 Cases. Original Research Article. Annals of Thoracic Surgery 2007, 83, 6, p. 1960-1964.

15. Wagner, A., Roeggla, M., Hirschl, M.M. et al. Tracheal rupture after emergency intubation during cardiopulmonary resuscitation. Original Research Article. Resuscitation 1995, 30, 3, p. 263-266.

16. Welter, S.., Krbek, T., Halder, R., Stamatis, G. A new technique for complete intraluminal repair of iatrogenic posterior tracheal lacerations (New ideas - Thoracic non-oncologic) Interact. CardioVasc. Thorac. Surg. 2011, 12, p. 6-9.