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Allergy and Airway |

Conservative Management of a Major Postintubation Tracheal Rupture

Ivan Romero-Legro, MD; Bassam Yaghmour, MD; Amado Freire, MD; Luis Murillo, MD
Chest. 2013;144(4_MeetingAbstracts):6A. doi:10.1378/chest.1705210
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Abstract

SESSION TITLE: Airway Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Tracheal rupture is a rare but life-threatening complication commonly seen after blunt trauma to the chest, penetrating gunshot and iatrogenic injury. Orotracheal intubation is reported to be the most common cause of iatrogenic tracheal injury. Early signs of intubation related tracheal rupture, such as respiratory distress, subcutaneous emphysema or death are usually present after the procedure.

CASE PRESENTATION: : 56 year-old woman developed acute respiratory failure due to COPD exacerbation. She was intubated after several attempts at the emergency department. A portable CXR post intubation revealed severe subcutaneous emphysema; a chest CT confirmed a tracheal rupture. A Bronchoscopy performed 12 hours after intubation showed a posterior tracheal rupture of 3-4 cm long located 1 cm above the carina, the membranous trachea lesion opened and closed on respiratory cycle. The location and length of the lesion and the patient being asymptomatic favored a conservative treatment with broad-spectrum antibiotics, fasting and post re-evaluation of the airway. The patient made a full and uncomplicated recovery

DISCUSSION: Tracheal rupture is a rare but potentially catastrophic event. When the injury is related to an intubation procedure, likely occurs in an emergency situation. The multiple factors leading to this injury are several attempts, inexperienced physicians, inappropriate use of styles, cuff over inflation, malposition of the tube and improper tube size. Two therapeutic approaches are proposed in the literature, surgical vs. medical management. Conservative management was chosen based on to the length and location of the laceration. It’s recommended to add empiric antibiotics, nothing by month for several days and offer analgesia if needed.

CONCLUSIONS: This case report presents an iatrogenic post-intubation tracheal rupture treated conservatively. It also illustrates the effectiveness of the non-surgical therapeutic strategy.

Reference #1: Carbognani P, Bobbio A, Cattelani L, Internullo E, Caporale D, Rusca M: Management of postintubation membranous tracheal rupture. Ann Thorac Surg 2004, 77:406-409.

DISCLOSURE: The following authors have nothing to disclose: Ivan Romero-Legro, Bassam Yaghmour, Amado Freire, Luis Murillo

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