title: Strategies for diagnosis and treatment of iatrogenic tracheal ruptures.
abstract: BACKGROUND
  Management of tracheal ruptures in critically ill patients is challenging. Conservative treatment has been described, but in mechanically ventilated patients with distal tracheal ruptures surgical repair might be inevitable. Strategies for diagnosis and treatment of tracheal ruptures and handling of mechanical ventilation remain to be clarified. Our aim was to comprise a structured diagnostic and treatment protocol for patients suspicious of tracheal injury, including detailed principles of mechanical ventilation and specific indications for conservative or surgical treatment.
  
  
  METHODS
  Patients with tracheal ruptures were compared in accordance to the need of mechanical ventilation and to indication for surgical repair. In patients suffering from tracheal ruptures affecting the whole tracheal wall and with protrusion of mediastinal structures into the lumen surgery was indicated. We compared ventilatory, hemodynamic and clinical parameters between the different patient groups. We report our structured approach in diagnostics and treatment of tracheal ruptures and place special emphasis on respiratory management.
  
  
  RESULTS
  Seventeen patients with tracheal rupture were identified. In 8 patients surgical repair was performed 1.8±1.5 days after diagnosis. Previous to surgery, ventilation parameters improved significantly: plateau pressure decreased, percentage of assisted spontaneous breathing increased and compliance improved. Conservative treatment was successful in long-term ventilated patients (13.7±8 days) even when suffering from distal lesions.
  
  
  CONCLUSIONS
  Invasiveness of mechanical ventilation and obstruction of tracheal lumen might indicate conservative or surgical treatment strategies in long-term ventilated patients suffering from iatrogenic tracheal rupture. Indications for surgical repair remain to be further clarified.
authors: Department of Anesthesiology and Intensive Care Medicine, Charité, Berlin Medical University, Campus Virchow-Klinikum, Campus Charité Mitte, Berlin, Germany. maria.deja@charite.de
authors: M
authors: M
authors: Deja
authors: M
authors: M
authors: Menk
authors: C
authors: C
authors: Heidenhain
authors: C D
authors: CD
authors: Spies
authors: A
authors: A
authors: Heymann
authors: H
authors: H
authors: Weidemann
authors: D
authors: D
authors: Branscheid
authors: S
authors: S
authors: Weber-Carstens