Subscribe to RSS
DOI: 10.1055/a-2182-7126
Tracheobronchiale Verletzungen
Tracheobronchial InjuriesZusammenfassung
Tracheobronchiale Verletzungen sind selten, gehen aber mit einer hohen Morbidität und Letalität einher. Dies liegt vor allem in Nebenerkrankungen und Begleitverletzungen der Patienten begründet. Eine grundsätzliche Klassifikation differenziert tracheobronchiale Verletzungen nach iatrogener Ursache sowie stumpfen wie auch penetrierenden Traumata.
Die genaue Inzidenz der Verletzungen ist unklar, da viele iatrogene Verletzungen inapparent verlaufen und ein Großteil der Patienten nach einer traumatischen Verletzung vor einer Behandlung im Krankenhaus verstirbt.
Patienten mit Verdacht auf eine tracheobronchiale Verletzung verlangen daher nach besonderer Aufmerksamkeit, einer schnellen Diagnostik und zügigem therapeutischem Vorgehen.
Die häufigsten Symptome sind Dyspnoe, Hämoptysen, Hautemphysem und Stridor. Die Bronchoskopie stellt die wichtigste diagnostische Maßnahme zur Beurteilung des Ausmaßes der Verletzung dar.
In Abhängigkeit der diagnostischen Befunde und dem klinischen Erscheinungsbild der Patienten gibt es verschiedene therapeutische Optionen, wobei das konservative Management an Bedeutung gewinnt. Gerade bei schwerstkranken Patienten kann im Rahmen eines risikostratifizierten Vorgehens neben einem operativen Eingriff oder einer bronchoskopischen Stentimplantation auch ein rein konservatives Vorgehen gewählt werden. Zur Planung des therapeutischen Managements ist bei jedem Patienten die jeweilige Symptomatik wegweisend.
Abstract
Tracheobronchial injury is a rare, but potentially life-threatening condition. These injuries are associated with high morbidity and mortality, which is ascribed to underlying diseases and additional injuries. Lacerations of the airway are differentiated into iatrogenic and non-iatrogenic injuries, while the group of non-iatrogenic lesions are grouped into blunt and penetrating traumas.
The exact incidence of tracheobronchial injury is unknown, because many iatrogenic injuries occur without symptoms and most patients after traumatic laceration die before inpatient treatment. All patients with suspicion of airway injury require fast and accurate management.
Common signs and symptoms are dyspnoea, haemoptysis, stridor and subcutaneous emphysema.
Bronchoscopy is the most important tool for diagnosis and in several cases also for initial treatment.
Further management depends on the patient’s clinical condition and findings of bronchoscopy and computed tomography. Surgery has been the cornerstone of therapy, but in selected patients bronchoscopic stent implantation or conservative management must be discussed.
Publication History
Received: 25 July 2023
Accepted after revision: 26 September 2023
Article published online:
26 October 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Massard G, Rougé C, Dabbagh A. et al. Tracheobronchial lacerations after intubation and tracheostomy. Ann Thorac Surg 1996; 61: 1483-1487 DOI: 10.1016/0003-4975(96)00083-5. (PMID: 8633963)
- 2 Borasio P, Ardissone F, Chiampo G. Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg 1997; 12: 98-100 DOI: 10.1016/s1010-7940(97)00111-5. (PMID: 9262088)
- 3 Schneider T, Volz K, Dienemann H. et al. Incidence and treatment modalities of tracheobronchial injuries in Germany. Interact Cardiovasc Thorac Surg 2009; 8: 571-576 DOI: 10.1510/icvts.2008.196790. (PMID: 19211582)
- 4 Grewal HS, Dangayach NS, Ahmad U. et al. Treatment of Tracheobronchial Injuries: A Contemporary Review. Chest 2019; 155: 595-604 DOI: 10.1016/j.chest.2018.07.018. (PMID: 30059680)
- 5 Kalverkamp S, Störmann P, Graeff P. et al. Traumatische tracheobronchiale Verletzungen – Empfehlungen der Interdisziplinären Arbeitsgruppe der DGT und DGU zur Etablierung einer einheitlichen Klassifikation für Diagnostik und Therapie. Zentrabl Chir 2023; 148: 85-92 DOI: 10.1055/a-1970-3555. (PMID: 36822184)
- 6 Herrmann D, Volmerig J, Oggiano M. et al. Tracheal surgery in Germany. Curr Chall Thorac Surg 2020; 2: 7 DOI: 10.21037/ccts.2019.12.02.
- 7 Welter S, Essaleh W. Management of tracheobronchial injuries. J Thorac Dis 2020; 12: 6143-6151 DOI: 10.21037/jtd-2019-as-05. (PMID: 33209452)
- 8 Madden BP. Evolutional trends in the management of tracheal and bronchial injuries. J Thorac Dis 2017; 9: E67-E70 DOI: 10.21037/jtd.2017.01.43. (PMID: 28203439)
- 9 Welter S, Hoffmann H. [Injuries of the trachea-bronchial tree]. Zentralbl Chir 2013; 138: 111-116 DOI: 10.1055/s-0032-1328269. (PMID: 23450402)
- 10 Bertelsen S, Howitz P. Injuries of the trachea and bronchi. Thorax 1972; 27: 188-194 DOI: 10.1136/thx.27.2.188. (PMID: 5034596)
- 11 Schibilsky D, Driessen A, White WJ. et al. Traumatic tracheobronchial injuries: incidence and outcome of 136.389 patients derived from the DGU traumaregister. Sci Rep 2020; 10: 20555 DOI: 10.1038/s41598-020-77613-x. (PMID: 33239731)
- 12 Herrmann D, Volmerig J, Alturki A. et al. Does less surgical trauma result in better outcome in management of iatrogenic tracheobronchial laceration?. J Thorac Dis 2019; 11: 4772-4781 DOI: 10.21037/jtd.2019.10.22. (PMID: 31903267)
- 13 Miñambres E, Burón J, Ballesteros MA. et al. Tracheal rupture after endotracheal intubation: a literature systematic review. Eur J Cardiothorac Surg 2009; 35: 1056-1062 DOI: 10.1016/j.ejcts.2009.01.053. (PMID: 19369087)
- 14 Kaloud H, Smolle-Juettner FM, Prause G. et al. Iatrogenic ruptures of the tracheobronchial tree. Chest 1997; 112: 774-778 DOI: 10.1378/chest.112.3.774. (PMID: 9315814)
- 15 Hofmann HS, Rettig G, Radke J. et al. Iatrogenic ruptures of the tracheobronchial tree. Eur J Cardiothorac Surg 2002; 21: 649-652 DOI: 10.1016/s1010-7940(02)00037-4. (PMID: 11932162)
- 16 Boutros J, Marquette CH, Ichai C. et al. Multidisciplinary management of tracheobronchial injury. Eur Respir Rev 2022; 31: 210126 DOI: 10.1183/16000617.0126-2021. (PMID: 35082126)
- 17 Cardillo G, Carbone L, Carleo F. et al. Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non-surgical treatment. Eur J Cardiothorac Surg 2010; 37: 581-587 DOI: 10.1016/j.ejcts.2009.07.034. (PMID: 19748275)
- 18 Cardillo G, Ricciardi S, Forcione AR. et al. Post-intubation tracheal lacerations: Risk-stratification and treatment protocol according to morphological classification. Front Surg 2022; 9: 1049126 DOI: 10.3389/fsurg.2022.1049126. (PMID: 36504581)
- 19 Krämer S, Broschewitz J, Kirsten H. et al. Prognostic factors for iatrogenic tracheal rupture: A single-center retrospective cohort study. J Clin Med 2020; 9: 382 DOI: 10.3390/jcm9020382. (PMID: 32024043)
- 20 Schneider T, Storz K, Dienemann H. et al. Management of iatrogenic tracheobronchial injuries: a retrospective analysis of 29 cases. Ann Thorac Surg 2007; 83: 1960-1964 DOI: 10.1016/j.athoracsur.2007.01.042. (PMID: 17532378)
- 21 Gómez-Caro Andrés A, Moradiellos Díez FJ, Ausín Herrero P. et al. Successful conservative management in iatrogenic tracheobronchial injury. Ann Thorac Surg 2005; 79: 1872-1878 DOI: 10.1016/j.athoracsur.2004.10.006. (PMID: 15919275)
- 22 Jougon J, Ballester M, Choukroun E. et al. Conservative treatment for postintubation tracheobronchial rupture. Ann Thorac Surg 2000; 69: 216-220 DOI: 10.1016/s0003-4975(99)01129-7. (PMID: 10654516)
- 23 Conti M, Pougeoise M, Wurtz A. et al. Management of postintubation tracheobronchial ruptures. Chest 2006; 130: 412-418 DOI: 10.1378/chest.130.2.412. (PMID: 16899839)
- 24 Welter S. Repair of tracheobronchial injuries. Thorac Surg Clin 2014; 24: 41-50 DOI: 10.1016/j.thorsurg.2013.10.006. (PMID: 24295658)
- 25 D’Andrilli A, Rendina EA. Stenting treatment is a minimally traumatic and effective alternative to surgical repair for iatrogenic tracheobronchial lesion. J Thorac Dis 2020; 12: 137-139 DOI: 10.21037/jtd.2020.01.48. (PMID: 32274074)
- 26 Passera E, Orlandi R, Calderoni M. et al. Post-intubation iatrogenic tracheobronchial injuries: The state of art. Front Surg 2023; 10: 1125997 DOI: 10.3389/fsurg.2023.1125997. (PMID: 36860949)
- 27 Evermann M, Roesner I, Denk-Linnert DM. et al. Cervical repair of iatrogenic tracheobronchial injury by tracheal T-incision. Ann Thorac Surg 2022; 114: 1863-1870 DOI: 10.1016/j.athoracsur.2022.03.019. (PMID: 35346636)
- 28 Angelillo-Mackinlay T. Transcervical Repair of distal membranous tracheal laceration. Ann Thorac Surg 1995; 59: 531-532 DOI: 10.1016/0003-4975(94)00882-8. (PMID: 7847986)
- 29 Welter S, Krbek T, Halder R. et al. A new technique for complete intraluminal repair of iatrogenic posterior tracheal lacerations. Interact Cardiovasc Thorac Surg 2011; 12: 6-9 DOI: 10.1510/icvts.2010.248641. (PMID: 20921002)
- 30 Cakmak G, Cansun F, Saracoglu A. et al. Airway management in penetrating thoracic trauma. Anaestesiol Intensive Ther 2022; 3: 253-261 DOI: 10.5114/ait.2022.118332. (PMID: 36000693)
- 31 Kiser AC, O’Brien SM, Detterbeck FC. Blunt tracheobronchial injuries: Treatment and outcomes. Ann Thorac Surg 2001; 71: 2059-2065 DOI: 10.1016/s0003-4975(00)02453-x. (PMID: 11426809)
- 32 Prokakis C, Koletsis EN, Dedeilias P. et al. Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg 2014; 9: 117 DOI: 10.1186/1749-8090-9-117. (PMID: 24980209)
- 33 Carretta A, Ciriaco P, Bandiera A. et al. Diagnostic and therapeutic approach to post-traumatic tracheobronchial injuries. Signa Vitae 2021; 17: 10-19 DOI: 10.22514/sv.2021.015.
- 34 Cakmak G, Cansun F, Saracoglu A. et al. Airway management in penetrating thoracic trauma. Anaesthesiol Intensive Ther 2022; 54: 253-261 DOI: 10.5114/ait.2022.118332. (PMID: 36000693)
- 35 Jones TS, Sullivan A, Damle S. et al. Assessment and Management of postintubation airway injuries. Demin Cardiothorac Vasc Anesth 2017; 21: 99-104 DOI: 10.1177/1089253216647488. (PMID: 27166401)
- 36 Baumgartner FJ, Ayres B, Theuer C. Danger of false intubation after traumatic tracheal transection. Ann Thorac Surg 1997; 63: 227-228 DOI: 10.1016/s0003-4975(96)00691-1. (PMID: 8993273)
- 37 Carretta A, Melloni G, Bandiera A. et al. Conservative and surgical treatment of acute posttraumatic tracheobronchial injuries. World J Surg 2011; 35: 2568-2574 DOI: 10.1007/s00268-011-1227-z. (PMID: 21901327)
- 38 Han C, Kim SH, Park SJ. et al. Successful management of blunt tracheal injury by endotracheal-stent placement. Asian J Surg 2023; 46: 1341-1342 DOI: 10.1016/j.asjsur.2022.08.104. (PMID: 36089440)