title: Perioperative management of laryngotracheobronchial injury: our experience in a level 1 trauma centre.
abstract: OBJECTIVE
  Laryngotracheobronchial injuries (LTBI) are serious injuries because of their consequences in terms of ventilation, coupled with the severity of other injuries associated with them. We share our experience in managing these patients perioperatively in our level 1 trauma centre.
  
  
  METHODS
  A retrospective analysis of the records of 30 patients with LTBI who presented at Jai Prakash Narayan Apex Trauma Center (JPNATC) from December 2007 to February 2011 was done. The demographics, mechanism of injury, clinical presentation, diagnostic modalities, anaesthetic management and outcome in these patients were reviewed.
  
  
  RESULTS
  Intrathoracic location of the injury and Injury Severity Score (ISS) had a direct correlation with the outcome of the patients. The overall mortality was 6.7 %.
  
  
  CONCLUSIONS
  Meticulous examination, details about the mechanism of injury, careful diagnostic evaluation, and skilful airway and surgical management are necessary for a better outcome in patients with airway injuries. A high degree of suspicion in occult injuries and liberal use of a fibreoptic bronchoscope aids diagnosis and management. Prompt airway management in the pre-hospital setting before transfer to a higher level trauma centre ensures better outcomes.
authors.affiliation: Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India. drbabitagupta@hotmail.com.|, I-22 (Ground Floor), South City II, Gurgaon, Haryana, India. drbabitagupta@hotmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Gupta
authors.affiliation: Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India. chandni.doc@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Sinha
authors.affiliation: Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India. ajeetdoc@yahoo.co.in.
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India. drchandankumardey@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Dey
authors.affiliation: Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Ramchandani
authors.affiliation: Department of Surgery, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India. Subodh6@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India. chhavipapneja@yahoo.co.in.
authors.forename: C
authors.initials: C
authors.lastname: Sawhney
authors.affiliation: Department of Surgery, Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India. mcmisra@gmail.com.
authors.forename: M C
authors.initials: MC
authors.lastname: Misra
keywords: Airway; Bronchoscopy; Laryngotracheal
references.citation: J Trauma. 1988 Sep;28(9):1353-7
references.pmid: 3418760
references.citation: Thorac Surg Clin. 2007 Feb;17(1):35-46
references.pmid: 17650695
references.citation: J Surg Educ. 2008 Jul-Aug;65(4):302-8
references.pmid: 18707665
references.citation: Semin Thorac Cardiovasc Surg. 2008 Spring;20(1):52-7
references.pmid: 18420127
references.citation: Am J Surg. 1985 Dec;150(6):710-5
references.pmid: 4073364
references.citation: Emerg Med J. 2003 Jul;20(4):391-3
references.pmid: 12835372
references.citation: Ann Thorac Surg. 1993 Jul;56(1):160-1
references.pmid: 8328850
references.citation: Arch Otolaryngol. 1983 Jan;109(1):56-9
references.pmid: 6848109
references.citation: Ann Thorac Surg. 2000 May;69(5):1563-7
references.pmid: 10881842
references.citation: JAMA. 1962 Aug 25;181:682-6
references.pmid: 13874883
references.citation: Anaesth Intensive Care. 2002 Apr;30(2):145-52
references.pmid: 12002920
references.citation: Chest. 1994 Jul;106(1):74-8
references.pmid: 8020323
references.citation: Ann Thorac Surg. 1998 Jan;65(1):182-6
references.pmid: 9456114
references.citation: J Pediatr Surg. 1991 Nov;26(11):1316-9
references.pmid: 1812265
references.citation: J Thorac Surg. 1947 Oct;16(5):571-83
references.pmid: 20267960
references.citation: Can J Anaesth. 1994 Dec;41(12):1208-10
references.pmid: 7867118
references.citation: Can J Anaesth. 1996 Feb;43(2):148-59
references.pmid: 8825540
references.citation: J Trauma. 2004 Jan;56(1):30-6
references.pmid: 14749562
references.citation: Ann Thorac Surg. 1990 Oct;50(4):569-74
references.pmid: 2222045
references.citation: Chest. 1990 May;97(5):1235-8
references.pmid: 2331919