MANAGEMENT OF TRACHEOBRONCHIAL DISRUPTION RESULTING FROM BLUNT TRAUMA

  • 1 January 1984
    • journal article
    • research article
    • Vol. 95  (3) , 319-323
Abstract
Delayed diagnosis of tracheobronchial disruption resulting from blunt trauma continues to cause major morbidity and death. At the University of Louisville [Kentucky, USA] from 1968-1982, 13 patients had tracheobronchial disruption resulting from blunt trauma. All injuries were caused by motor vehicle accidents. Disruptions were located in the trachea in 6 patients and in the right bronchus in 7 patients. Physical findings included subcutaneous emphysema (11 patients), respiratory distress (10 patients), hemoptysis (6 patients) and flail chest (4 patients). Four patients (30%) died, 3 from multiple major associated injuries and the other before therapy could be instituted. Among the 9 survivors, 6 had immediate diagnosis and prompt surgical treatment, which consisted of suture repair in 5 and pneumonectomy in the other patient. Two patients had delay in diagnosis, and repair was attempted at 4 and 30 days, respectively; bronchial stricture resulted in 1 and pneumonectomy, empyema and bronchopleural fistula in the other. Another patient with a bronchial mucosal tear was treated nonoperatively without complication. Tracheobronchial disruption should always be considered with massive blunt chest trauma. Repeated bronchoscopy is indicated for unexplained pleural air leaks, lobar atelectasis, or persistent pneumothorax. Prompt diagnosis and expeditious surgical therapy result in fewer complications and increased survival.

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