Management of Iatrogenic Tracheobronchial Injuries: A Retrospective Analysis of 29 Cases

Background: Tracheobronchial injuries are rare but potentially life-threatening complications of endotracheal intubations or endobronchial interventions. This retrospective analysis discusses the criteria for the operative and nonoperative management of tracheal lacerations. Methods: From July 1996 to June 2006, 29 patients with iatrogenic tracheobronchial injuries were diagnosed at our institution. The injury occurred during single-lumen tube intubation in 14 patients and during double-lumen tube intubation in 2 patients. Two ruptures were diagnosed after surgical tracheostomy, eight after dilational percutaneous tracheostomy, and three after interventional bronchoscopy. Results: The lacerations in 11 patients were superficial or were sufficiently covered by the esophagus, and they underwent conservative management. Bronchoscopy revealed healing per primam in every case. Surgical repair was done in 18 patients (62%). The transtracheal approach was used for repair in 7 patients; a right-sided posterolateral thoracotomy was performed in 11 patients with lacerations affecting the lower third of the trachea. Three surgical patients died from causes unrelated to the tracheal injury. No clinically evident mediastinitis or postoperative tracheobronchial stenosis was observed. Conclusions: The decision for operative or nonoperative treatment of iatrogenic tracheobronchial lacerations is determined by the ventilating situation and the local extent of the injury. Nonoperative management of iatrogenic tracheobronchial injuries may be a save option in patients with uncomplicated ventilation, superficial or sufficiently covered tears, and moderate and nonprogressive emphysema. Immediate surgical repair remains warranted in those patients who require mechanical ventilation that cannot be delivered past the laceration.