Iatrogenic Tracheobronchial Lesions - A Report on 13 Cases[1]

Background: Tracheobronchial ruptures are occurrences which mainly result from blunt or penetrating neck or thoracic trauma, but also from long-term complications of intubation or tracheostomy. Acute iatrogenic tracheobronchial lesions are very uncommon. Methods: From February 1995 to July 1998, we treated 13 patients (12 female, 1 male, mean age 68 years, range 45-86) in our institution for iatrogenic tracheobronchial injuries after single lumen intubation (n = 8), double lumen intubation (n = 4), and tracheostomy (n = 1). We retrospectively analyzed the medical records of these patients concerning age, sex, symptoms, endoscopic and intraoperative findings, treatment and outcome. Results: All patients underwent surgical treatment via right-sided thoracotomy. In the cases of 11 patients, repeated postoperative bronchoscopy revealed sufficient reconstruction of the lesions. Nevertheless, only 5 patients survived. The remainder died of the sequelae of trauma-related hypoxia, underlying (malignant) diseases, or of septic multiorgan failure after a median of 15 days (1 hour to 27 days). Conclusions: While technical problems of tracheobronchial reconstruction in our series were controllable, the long-term results were not satisfying. Our data suggest that the key for better outcome of these kind of lesions lies in an early diagnosis and immediate treatment, thus keeping the trauma-treatment interval with the concomitant hypoxic damage as short as possible.

Iatrogenic tracheobronchial lesions - Intubation complications - Surgical therapy

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1 Presented at the 28^th Annual Meeting of The German Society of Thoracic and Cardiovascular Surgery, Dresden, February 24 - 28, 1999