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Iatrogenic Ruptures of the Tracheobronchial Tree

Herbert Kaloud; Freya-Maria Smolle-Juettner; Gerhard Prause; Werner Franz List
Author and Funding Information

Affiliations: From the Department of Anaesthesiology, University Medical School of Graz, Austria,  From the Department of Thoracic and Hyperbaric Surgery, University Medical School of Graz, Austria

Affiliations: From the Department of Anaesthesiology, University Medical School of Graz, Austria,  From the Department of Thoracic and Hyperbaric Surgery, University Medical School of Graz, Austria


1997 by the American College of Chest Physicians


Chest. 1997;112(3):774-778. doi:10.1378/chest.112.3.774
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Abstract

We did a retrospective study in 12 patients with iatrogenic tracheal or tracheobronchial ruptures treated since 1975. Ten female subjects, one male subject, and one child (age range, 8 to 72 years), all of whom had undergone intratracheal intubation, were admitted to the hospital. Four patients had been intubated with a double-lumen catheter (two Carlens type with carinal spur, two Robertshaw without spur), and seven had had "high volume-low pressure" tubes, placed under emergency conditions in three of those seven cases. In one further case, an unsuccessful attempt of percutaneous tracheostomy had been made. The localization of the ruptures (all of them longitudinally in the membranaceous wall; length, 2 to 13 cm; mean, 7 cm) comprised both cervical and intrathoracic trachea in seven, the intrathoracic trachea in three instances, and the left main stem bronchus in two cases. Ten patients had mediastinal and subcutaneous emphysema, seven presented with a pneumothorax, and nine had intratracheal bleeding. The interval until the onset of symptoms and diagnoses differed widely: twice diagnoses were made intraoperatively, during thoracic surgery. The longest interval until diagnosis was 5 days; only then did the patient show subcutaneous emphysema and have retrosternal pain. All patients had surgical repair. Nine recovered without sequelae, and three died of septic multiorgan failure.


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