Successful conservative management in iatrogenic tracheobronchial injury.
BACKGROUND
The aim of this study was to describe and to assess the effectiveness of conservative treatment as the chosen treatment for managing iatrogenic tracheobronchial injuries (ITBI).


METHODS
Between January 1993 and December 2003, 33 tracheobronchial injuries were treated in our hospital. Eighteen (54.5%) were ITBI and 15 (45.5%) were traumatic noniatrogenic injuries. Of the ITBI patients, sex distribution was 15 (83%) females and 3 (17%) males with a mean age of 57.7 +/- 20.7 years (range, 17 to 88 years). Fifteen (83.3%) of the injuries were caused by orotracheal intubation and 3 (15.7%) by tracheotomy. The average diagnostic delay was 25.7 +/- 22.9 hours. The mean injury size was 2.83 +/- 1.02 cm (range, 1 to 4 cm). Nine (50%) injuries were located in the cervical trachea, 6 (33.3%) in the thoracic trachea, and 3 (16%) involved both trachea and main bronchi. Conservative treatment was chosen for 17 (94.4%) of the 18 cases. We performed surgical repair in only 1 case owing to progressive subcutaneous emphysema and increasing difficulty with mechanical ventilation.


RESULTS
No complications arose from the use of conservative treatment. Four patients (22%) died in our hospital, 3 of these of non-ITBI-related causes. Mortality was not related to four variables: sex, diagnostic delay, location, or size of the ITBI. Fourteen of the 18 patients (77.7%) were discharged uneventfully, and the endoscopic and clinical follow-up examinations were satisfactory in all patients.


CONCLUSIONS
Conservative treatment for ITBI is effective regardless of production, size, or site of the injuries. Surgical treatment is advisable in specific cases: rapid progression of subcutaneous and mediastinal emphysema, mediastinitis, and difficulty with mechanical ventilation.
Gómez-Caro Andrés
Abel
A
Department of Thoracic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain. abelitov@yahoo.es
Moradiellos Díez
Francisco Javier
FJ
Ausín Herrero
Pilar
P
Díaz-Hellín Gude
Vicente
V
Larrú Cabrero
Emilio
E
de Miguel Porch
Eduardo
E
Martín De Nicolás
José Luis
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007440:Intubation / Q000009:adverse effects*; D055370:Lung Injury; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014132:Trachea / Q000293:injuries*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy*