Conservative and surgical treatment of acute posttraumatic tracheobronchial injuries

Angelo Carretta, Giulio Melloni, Alessandro Bandiera, Giampiero Negri, Carlopietro Voci, Piero Zannini

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background Acute posttraumatic tracheobronchiallesions are rare events associated with significant morbidityand mortality. They are caused by blunt and penetratingtrauma, or they are iatrogenic, appearing after intubation ortracheotomy. Although surgery has traditionally beenconsidered the treatment of choice for these injuries, recentreports show that conservative treatment can be effective inselected patients. The aim of this study was to evaluate therole of surgical and conservative management of theselesions, differentiated on the basis of clinical and endoscopiccriteria.Methods From January 1993 to October 2010, a total of50 patients with acute posttraumatic tracheobronchiallesions were referred for treatment to our department. Inall, 36 patients had iatrogenic injuries of the airway, and 14had lesions resulting from blunt or penetrating trauma.Results Of the 30 patients who underwent surgery, thelesion was repaired with interrupted absorbable sutures in29; the remaining patient, with an associated tracheoesophagealfistula, underwent single-stage tracheal resectionand reconstruction and closure of the fistula. In all, 20patients were treated conservatively: clinical observation in5 patients, airway decompression wit a mini-tracheotomycannula in 4 spontaneously breathing patients, andtracheotomy with the cuff positioned distal to the lesion in11 mechanically ventilated patients. One surgical and oneconservatively-managed patient died after treatment (4%overall mortality). Complete recovery and healing wereachieved in all the remaining patients.Conclusions Surgery remains the treatment of choice forposttraumatic lesions of the airway. However, conservativetreatment based on strict clinical and endoscopic criteria-stable vital signs; effective ventilation; no esophagealinjuries, signs of sepsis, or evidence of major communicationwith the mediastinal space-enables favorable results to be achieved in selected patients.

Original languageEnglish
Pages (from-to)2568-2574
Number of pages7
JournalWorld Journal of Surgery
Volume35
Issue number11
DOIs
Publication statusPublished - Nov 2011

Fingerprint

Wounds and Injuries
Conservative Treatment
Wit and Humor
Mortality
Vital Signs
Therapeutics
Decompression
Intubation
Sutures
Fistula
Ventilation
Sepsis
Respiration
Observation

ASJC Scopus subject areas

  • Surgery

Cite this

Conservative and surgical treatment of acute posttraumatic tracheobronchial injuries. / Carretta, Angelo; Melloni, Giulio; Bandiera, Alessandro; Negri, Giampiero; Voci, Carlopietro; Zannini, Piero.

In: World Journal of Surgery, Vol. 35, No. 11, 11.2011, p. 2568-2574.

Research output: Contribution to journalArticle

Carretta, Angelo ; Melloni, Giulio ; Bandiera, Alessandro ; Negri, Giampiero ; Voci, Carlopietro ; Zannini, Piero. / Conservative and surgical treatment of acute posttraumatic tracheobronchial injuries. In: World Journal of Surgery. 2011 ; Vol. 35, No. 11. pp. 2568-2574.
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abstract = "Background Acute posttraumatic tracheobronchiallesions are rare events associated with significant morbidityand mortality. They are caused by blunt and penetratingtrauma, or they are iatrogenic, appearing after intubation ortracheotomy. Although surgery has traditionally beenconsidered the treatment of choice for these injuries, recentreports show that conservative treatment can be effective inselected patients. The aim of this study was to evaluate therole of surgical and conservative management of theselesions, differentiated on the basis of clinical and endoscopiccriteria.Methods From January 1993 to October 2010, a total of50 patients with acute posttraumatic tracheobronchiallesions were referred for treatment to our department. Inall, 36 patients had iatrogenic injuries of the airway, and 14had lesions resulting from blunt or penetrating trauma.Results Of the 30 patients who underwent surgery, thelesion was repaired with interrupted absorbable sutures in29; the remaining patient, with an associated tracheoesophagealfistula, underwent single-stage tracheal resectionand reconstruction and closure of the fistula. In all, 20patients were treated conservatively: clinical observation in5 patients, airway decompression wit a mini-tracheotomycannula in 4 spontaneously breathing patients, andtracheotomy with the cuff positioned distal to the lesion in11 mechanically ventilated patients. One surgical and oneconservatively-managed patient died after treatment (4{\%}overall mortality). Complete recovery and healing wereachieved in all the remaining patients.Conclusions Surgery remains the treatment of choice forposttraumatic lesions of the airway. However, conservativetreatment based on strict clinical and endoscopic criteria-stable vital signs; effective ventilation; no esophagealinjuries, signs of sepsis, or evidence of major communicationwith the mediastinal space-enables favorable results to be achieved in selected patients.",
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N2 - Background Acute posttraumatic tracheobronchiallesions are rare events associated with significant morbidityand mortality. They are caused by blunt and penetratingtrauma, or they are iatrogenic, appearing after intubation ortracheotomy. Although surgery has traditionally beenconsidered the treatment of choice for these injuries, recentreports show that conservative treatment can be effective inselected patients. The aim of this study was to evaluate therole of surgical and conservative management of theselesions, differentiated on the basis of clinical and endoscopiccriteria.Methods From January 1993 to October 2010, a total of50 patients with acute posttraumatic tracheobronchiallesions were referred for treatment to our department. Inall, 36 patients had iatrogenic injuries of the airway, and 14had lesions resulting from blunt or penetrating trauma.Results Of the 30 patients who underwent surgery, thelesion was repaired with interrupted absorbable sutures in29; the remaining patient, with an associated tracheoesophagealfistula, underwent single-stage tracheal resectionand reconstruction and closure of the fistula. In all, 20patients were treated conservatively: clinical observation in5 patients, airway decompression wit a mini-tracheotomycannula in 4 spontaneously breathing patients, andtracheotomy with the cuff positioned distal to the lesion in11 mechanically ventilated patients. One surgical and oneconservatively-managed patient died after treatment (4%overall mortality). Complete recovery and healing wereachieved in all the remaining patients.Conclusions Surgery remains the treatment of choice forposttraumatic lesions of the airway. However, conservativetreatment based on strict clinical and endoscopic criteria-stable vital signs; effective ventilation; no esophagealinjuries, signs of sepsis, or evidence of major communicationwith the mediastinal space-enables favorable results to be achieved in selected patients.

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