PURPOSE: Traumatic airway injury caused by intubation is a rare but serious complication associated with intubation. We report the outcome of conservative therapy of traumatic airway injury secondary to intubation.
METHODS: Retrospective observational cohort of all patients that suffered traumatic airway injury caused by intubation. Patient demographics, type of intubation (controlled vs. non controlled), site of injury, extent of injury and 30-day survival were studied.
RESULTS: Fourteen patients with traumatic airway injury were studied. The injuries occurred over an 8-year period between January 1, 2000 and March 31, 2008. Ten out of fourteen (71%) patients were female. The average age was 81.3 (±11). All injuries occurred in non-controlled settings; 2 (14%) pre hospital, 11 (79%) in the emergency department and 1 (7%) on a general medical-surgical floor. Experienced operators performed all intubations. The site of injury was the carina in two cases (14%), posterior tracheal wall in one (7%), six cases of laryngeal injury (43%), and in five (36%) the site of the injury was not identifiable. All patients presented with subcutaneous emphysema of the neck, twelve (86%) had diffuse subcutaneous emphysema, ten (71%) had pneumomediastinum on chest x-ray, and four (29%) had pnemothoraces requiring chest tubes. All patients were initially treated conservatively; one patient (with the tracheal wall injury) developed a mediastinal collection requiring surgical correction and died. Nine of the thirteen (69%) patients that were treated conservatively survived thirty days or greater.
CONCLUSION: Traumatic airway injury secondary to intubation presents with subcutaneous emphysema, pneumomedistinum, and less commonly pneumothorax. Conservative treatment of the injury results in a high thirty-day survival.
CLINICAL IMPLICATIONS: Conservative treatment of traumatic airway injuries as a result of intubation leads to good outcomes.
DISCLOSURE: Arjun Madhavan, No Financial Disclosure Information; No Product/Research Disclosure Information