title: Management of blunt tracheobronchial trauma in the pediatric age group.
abstract: BACKGROUND
  Tracheobronchial rupture (TBR) due to blunt chest trauma is a rare but life-threatening injury in the pediatric age group. The aim of this study was to propose a treatment strategy including bronchoscopy, surgery and extracorporeal membrane oxygenation (ECMO) to optimize the emergency management of these patients.
  
  
  METHODS
  We reviewed a series of 27 patients with post-traumatic TBR treated since 1996 in our pediatric trauma center.
  
  
  RESULTS
  Seven cases had persistent and large volume air leaks. Flexible bronchoscopy was performed in cases of persistent or large volume air leaks. It permitted accurate visualization of the rupture and its extent. It allowed for a clear-cut positioning of the endotracheal tube. Five were managed operatively. Four cases were considered to be life-threatening because of the combination of severe respiratory distress with hemodynamic instability. One of them had severe tracheal laceration and died. Another one had bilateral bronchi disconnection. Based on clinical and endoscopic findings, surgical repair was performed using extracorporeal membrane oxygenation as a ventilatory support. It provided quick relief from the injury, which was previously expected to result in a fatal issue.
  
  
  CONCLUSIONS
  Prompt diagnosis and accurate management of surviving patients admitted to emergency rooms are necessary. Bronchoscopy remains a critical diagnosis step. Surgery is warranted for large tracheobronchial tears and ECMO could be beneficial as supportive therapy for selected cases.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059, Toulouse Cedex 9, France. q.ballouhey@gmail.com.
authors.forename: Q
authors.initials: Q
authors.lastname: Ballouhey
authors.affiliation: Department of Pediatric Anesthesiology, Children's Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059, Toulouse Cedex 9, France.
authors.forename: R
authors.initials: R
authors.lastname: Fesseau
authors.affiliation: Department of Cardiac Surgery, Rangueil Hospital, 1 Av J. Poulhes, 31059, Toulouse Cedex 9, France.
authors.forename: V
authors.initials: V
authors.lastname: Benouaich
authors.affiliation: Department of Radiology, Rangueil Hospital, 1 Av J. Poulhes, 31059, Toulouse Cedex 9, France.
authors.forename: S
authors.initials: S
authors.lastname: Lagarde
authors.affiliation: Pediatric Intensive Care Unit, Children's Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059, Toulouse Cedex 9, France.
authors.forename: S
authors.initials: S
authors.lastname: Breinig
authors.affiliation: Department of Pediatric Cardiac Surgery, Children's Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059, Toulouse Cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Léobon
authors.affiliation: Department of Pediatric Surgery, Children's Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059, Toulouse Cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Galinier
keywords: Bronchoscopy; Children; ECMO; Tracheobronchial trauma
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