Nonoperative management of tracheobronchial injuries in severely injured patients.
OBJECTIVE
A rupture of the airway due to blunt chest trauma is rare, and treatment can prove challenging. Many surgeons suggest operative management for these kinds of injuries. Nonoperative therapy is reported only in exceptional cases. But there is still a lack of evidence from which to recommend surgical repair of these injuries as the first choice procedure.


METHODS
We retrospectively analyzed the records of 92 multiple injured patients admitted to our trauma department between July 2002 and July 2003 for the incidence and management of tracheobronchial rupture (TBR).


RESULTS
Five (5.4%) of 92 patients suffered from tracheobronchial injuries. The mean injury severity score was 38. There were three male and two female patients, with a mean age of 23 years. All patients had lesions <2 cm in size and were treated nonoperatively. One patient died from multiorgan failure, but the others recovered from TBR uneventfully. One patient developed acute pneumonia as a result of respirator therapy, but none of the patients had mediastinitis or tracheal stenosis within 3 months after injury.


CONCLUSIONS
We believe that surgical treatment is not mandatory in patients with small to moderate ruptures, and such aggressive treatment may even have adverse effects, especially in patients with multiple injuries.
Kuhne
Christian A
CA
Departments of Traumasurgery, University Hospital of Essen, Germany.
Kaiser
Gernot M
GM
Flohe
Sascha
S
Beiderlinden
Martin
M
Kuehl
Hilmar
H
Stavrou
Gregor A
GA
Waydhas
Christian
C
Lendemanns
Sven
S
Paffrath
Thomas
T
Nast-Kolb
Dieter
D
D000293:Adolescent; D000328:Adult; D001980:Bronchi / Q000293:injuries*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000628:therapy*; D014132:Trachea / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000628:therapy*