Tracheobronchial injury after blunt thoracic trauma – lessons to learn in diagnosis, treatment, and postoperative care

Background Tracheobronchial injury (TBI) is the subsuming term to describe rare and mostly traumatic damage to the tracheobronchial tree. Prehospital mortality is significant. TBI patients may face delayed diagnosis, challenging perioperative care, and prolonged recovery.

Methods & Materials This is a single-center retrospective case-series study from an academic trauma referral center. We identified all cases of traumatic TBI referred to our hospital from January 2020, to December 2023, through an in-house database search (n=15). We excluded minors, patients with traumatic airway injuries caused by sharp objects, such as knives, and any iatrogenic lesions. This resulted in four patients being included in the study (ICD-10: S27.4/S27.5). One patient is female and the other three are male. Age at the time of the incident ranged from 24 to 59 with a mean of 47.75 years.

Results Lesson I: High-quality bronchoscopy is the gold standard for diagnosing TBI in any case of clinical suspicion.

Lesson II: Consider all perioperative options for optimal oxygenation, including ECMO therapy, to facilitate good surgical conditions and the best possible therapeutic outcome.

Lesson III: Always try to preserve all functional lung tissue through bronchoplastic reconstruction. Avoid anatomical resection.

Lesson IV: The more central the location of the lesion, the more the postoperative course is influenced by problems of altered secretion clearance due to possible traumatic denervation of the bronchial mucosa.

Conclusion TBI management requires a multidisciplinary and experienced team.

It is crucial that hospitals of different levels work together.

One must be aware of the classic clinical presentation: dyspnea, soft tissue emphysema, and hemoptysis.

Cases in which a history of trauma is associated with dyspnea and/or chest wall/mediastinal emphysema require early bronchoscopy as the diagnostic gold standard.

The use of „MinIP“ reconstructions can help identify TBI in CT scans.

Sufficient perioperative oxygenation of the patient must always be ensured. ECMO therapy is to be considered in selected cases.

Surgical repair must focus on preventing parenchymal loss by reconstructing the bronchial defect while avoiding anatomical resection.

Postoperative care should consider the possibility of bronchial denervation and its potential complications.

We recommend post-hospital rehabilitation and follow-up for all TBI patients.

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Artikel online veröffentlicht:
13. August 2024