Abstract
In this report, we describe a patient in whom a tracheal tear followed blunt thoracic trauma. The diagnosis was made late resulting in problems with ventilation, endotracheal tube obstruction and cardiac arrest. Difficulties with early recognition of tracheobronchial injuries may be caused by non-specific findings as well as the lack of exposure of physicians to patients with these injuries. The signs and symptoms of tracheobronchial injuries are described, as well as their differential diagnoses. A review of airway management has been made as it requires combined anaesthetic and surgical expertise. Injuries of the trachea may have severe, life-threatening consequences and early diagnosis and management reduce morbidity and mortality.
Résumé
Cette observation décrit l’évolurion d’un patient victime d’une déchirure trachéale à la suite d’un traumatisme thoracique fermé. Des problèmes ventilatoires, une obstruction de la canule endotrachéale et un arrêt cardiaque ont orienté vers ce diagnostic. La difficulté de reconnaître précocement une blessure trachéobronchique peut provenir aussi bien de la non spécificité des symptômes que de l’expérience du médecin qui traite ce type de blessure. Les signes et symptômes des blessures trachéobronchiques sont détaillés ainsi que le diagnostic différentiel. On attire l’attention sur la gestion des voies aériennes qui nécessite autant de compétence de la part de l’anesthésiste que du chirurgien. Les blessures à la trachée peuvent avoir des répercussions graves et le diagnostic et une gestion précoces en réduisent la morbidité et la mortalité.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Kelly JP, Webb WR, Moulder PV, Everson C, Burch BH, Lindsey ES. Management of airway trauma I: Tracheobronchial injuries. Ann Thorac Surg 1985; 40: 551–5.
Graver FL, Ellestad CE, Arom KV, Root HD, Cruz AB, Trinkle JK. Diagnosis and management of major tracheobronchial injuries. Ann Thorac Surg 1979; 28: 384–91.
Eijgelaar A, van der Heide JNH. A reliable early symptom of bronchial or tracheal rupture. Thorax 1970; 25: 120–5.
Chavez CM, Anas P, Conn JH. Surgical approach to injuries of the cervical trachea. South Med J 1972; 65: 659–60.
Meinke AH, Bivins BA, Sachatello CR. Selective management of gunshot wounds to the neck. Am J Surg 1979; 138: 314–9.
Chesterman JT, Satsangi PN. Rupture of the trachea and bronchi by closed injury. Thorax 1966; 21: 21–7.
Palmer MT, Turney SZ. Tracheal rupture and atlantooccipital dislocation: case report. J Trauma 1994; 37: 314–7.
Shimazu T, Sugimoto H, Nishide K, et al. Tracheobronchial rupture caused by blunt chest trauma: acute respiratory management. Am J Emerg Med 1988; 6: 427–34.
Barnhart GR, Brooks JW, Kellum JM. Pneumoperitoneum resulting from tracheal rupture following blunt chest trauma. J Trauma 1986; 26: 486–8.
Nakayama DK, Rowe MI. Intrathoracic tracheobronchial injuries in childhood. Int Anesthesiol Clin 1988; 26: 42–9.
Unger JM, Schuchmann GG, Grossman JE, Pellett JR. Tears of the trachea and main bronchi caused by blunt trauma: radiologic findings. American Journal of Roentgenology 1989; 153: 1175–80.
Guest JL Jr, Anderson JN. Major airway injury in closed chest trauma. Chest 1977; 72: 63–6.
Palder SB, Shandling B, Manson D. Rupture of the thoracic trachea following blunt trauma: diagnosis by CAT scan. J Pediatr Surg 1991; 26: 1320–2.
Burke JF. Early diagnosis of traumatic rupture of the bronchus. JAMA 1962; 181: 682–6.
Westaby S. Injury to the major airways. Br J Hosp Med 1985; 34: 210–20.
Symbas PN, Justicz AG, Ricketts RR. Rupture of the airways from blunt trauma: treatment of complex injuries. Ann Thorac Surg 1992; 54: 177–83.
St. Cyr JA, Fullerton DA, Zamora M, Hopeman AR. Tracheobronchial disruption: postoperative management with jet ventilation to minimize airway pressures. J Cardiovasc Surg 1994; 35: 79–81.
Ayabe H, Tsuji A, Akamine S, Tagawa Y, Kawahara K, Tomita M. Combined transection of the trachea and esophagus following cervical blunt trauma. Thorac Cardiovasc Surg 1993; 41: 193–5.
Santora AH, Wroe WA. Anesthetic considerations in traumatic tracheobronchial rupture. South Med J 1986; 79: 910–1.
Feinstein R, Owens WD. Anesthesia for ear, nose, and throat surgery.In: Barash PG, Cullen BF, Stoelting RK. (Eds.). Clinical Anesthesia, 2nd Ed. Philadelphia: JB Lippincott, 1992: 1122.
Dreyfuss D, Jackson RS, Coffin LH, Deane RSD, Shinozaki T. High-frequency ventilation in the management of tracheal trauma. J Trauma 1986; 26: 287–9.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Henderson, C.L., Rose, S.R. Tracheal rupture following blunt chest trauma presenting as endotracheal tube obstruction. Can J Anaesth 42, 816–819 (1995). https://doi.org/10.1007/BF03011185
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03011185