title: Management of postintubation tracheobronchial ruptures.
abstract: OBJECTIVE
  To determine whether nonoperative management can be applied to iatrogenic postintubation tracheobronchial rupture (TBR).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Thirty consecutive patients with TBR complicating intubation between June 1993 and December 2005 entered the study. Patients not receiving mechanical ventilation at time of diagnosis were treated nonsurgically. Patients receiving mechanical ventilation who were judged operable underwent surgical repair, while nonoperable candidates had their TBR bridged by endotracheal tubes.
  
  
  RESULTS
  Fifteen patients not requiring mechanical ventilation underwent simple conservative management. TBR length measured 3.85 +/- 1.46 cm (mean +/- SD). Eight TBRs showed full-thickness rupture with frank anterior intraluminal protrusion of the esophagus. In three patients, transient noninvasive positive pressure ventilatory support (NIV) was necessary. All lesions healed without sequelae. Two patients receiving mechanical ventilation underwent surgical repair and died. Thirteen patients receiving mechanical ventilation were considered at high surgical risk, and TBR bridging was attempted as salvage therapy. Complete bridging was achieved in five patients by simply advancing the endotracheal tube distal to the injury. Separate bilateral mainstem endobronchial intubation was necessary in six patients whose TBRs were too close to the carina. Nine of 13 patients (69%) treated with nonoperative therapy completely recovered.
  
  
  CONCLUSIONS
  We conclude that conservative nonoperative therapy should be considered in patients with postintubation TBR who are breathing spontaneously, or when extubation is scheduled within 24 h from the time of diagnosis, or when continued ventilation is required to treat an underlying respiratory status. Surgical repair should be reserved for cases in which NIV or bridging the lesion is technically not feasible.
authors.affiliation: Clinique de Chirurgie Thoracique, CHRU Lille, France.
authors.forename: Massimo
authors.initials: M
authors.lastname: Conti
authors.forename: Marie
authors.initials: M
authors.lastname: Pougeoise
authors.forename: Alain
authors.initials: A
authors.lastname: Wurtz
authors.forename: Henri
authors.initials: H
authors.lastname: Porte
authors.forename: François
authors.initials: F
authors.lastname: Fourrier
authors.forename: Philippe
authors.initials: P
authors.lastname: Ramon
authors.forename: Charles-Hugo
authors.initials: CH
authors.lastname: Marquette
mesh_terms: D000328:Adult; D000368:Aged; D001980:Bronchi / Q000293:injuries*; D001982:Bronchial Diseases / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012421:Rupture; D013908:Thoracotomy / Q000379:methods*; D014132:Trachea / Q000293:injuries*; D014133:Tracheal Diseases / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome