title: Severe tracheobronchial injuries: our experience.
abstract: BACKGROUND
  Severe tracheobronchial injuries (TBI) in children are usually traumatic or iatrogenic. However, they can also be caused by mediastinal infections that lead to critical situations. We herein report our experience in the treatment of these lesions.
  
  
  METHODS
  A retrospective study was conducted for patients treated at our center from 2008 to 2014. TBI was diagnosed by imaging studies and bronchoscopy. Treatment was initially conservative (drainage of air and secretions, mechanical ventilation with minimal pressures, and an early extubation) with a limited use of surgical procedures whenever necessary.
  
  
  RESULTS
  A total of 10 patients (7 males and 3 females) with a median age of 7.5 years (range, 3-17 years) suffered TBI. The mechanism was traumatic in six (three accidental and three iatrogenic) and mediastinal infection in four (three mycotic and one bacterial abscesses). All traumatic cases responded to conservative measures, except one iatrogenic lesion, which was surgically repaired. There were no complications or residual damages. Two patients with mediastinal infection presented with sudden cardiorespiratory arrest, one with hemoptysis caused by an arteriotracheal fistula and the other because of carinal rupture. Both died before any therapeutic measures could be taken. The other two patients were treated, one with previous extracorporeal membrane oxygenation support, underwent arterial embolization, but ultimately died, and the other one survived, but required esophagectomy and creation of a thoracostome for secondary wound closure of the bronchocutaneous fistula.
  
  
  CONCLUSIONS
  Conservative treatment with gentle respiratory support suffices in most traumatic cases of TBI. Infectious abscesses with involvement of adjacent structures sometimes require complex surgery and are life-threatening.
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Dominguez
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: De La Torre
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Alejandra Vilanova
authors.initials: AV
authors.lastname: Sánchez
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Hernandez
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Ruben
authors.initials: R
authors.lastname: Ortiz
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Ane M Andres
authors.initials: AM
authors.lastname: Moreno
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Encinas
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Vazquez
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Manuel Lopez
authors.initials: ML
authors.lastname: Santamaria
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Tovar
mesh_terms: D000293:Adolescent; D001980:Bronchi / Q000293:injuries* / Q000601:surgery; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004322:Drainage; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D055370:Lung Injury / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D019838:Neck Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014132:Trachea / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome