Current reviewBlunt tracheobronchial injuries: treatment and outcomes
Section snippets
Case report
A 28-year-old man was in good health until a 2.5-ton load of steel rods fell on his right chest and leg. He had several fractures, an associated right pneumothorax, and a pulmonary contusion. During his extended course in the intensive care unit, he experienced recurrent mucus plugging on the right and a persistent right superior pneumothorax, despite having a right chest tube placed on admission and a second tube placed 11 days later. Two weeks after the injury he underwent bronchoscopy that
Material and methods
We performed a thorough review of the literature published between 1873 and 1996, identifying all patients reported with blunt tracheobronchial injuries. This included all reports listed in Medline (using key words: trachea, bronchus, blunt, injury), as well as all other cases that could be identified from listed references in published articles.∗ We limited the study to patients with intrathoracic tracheal or bronchial injury, excluding those with cervical injuries. Collected information
Statistics
We assessed the statistical association between patient demographic and clinical characteristics and several outcomes. Comparisons involving time until diagnosis, time until treatment, and distance from injury to carina were evaluated using the Wilcoxon rank sum statistic. Associations between death from tracheobronchial injury and patient age, era, time until diagnosis, and time until treatment were assessed using a Mantel-Haenszel χ-square test for trend. Associations between death from
Demographics, cause of injury
A total of 265 patients with blunt tracheobronchial injury were collected, including the patient reported here and all other patients published in the literature. The demographics and clinical characteristics of the patients are reported in Table 1. Patient ages ranged from 1 to 74 years, with a median age of 20 years. More than half of the injuries (54%) involved persons between 10 and 29 years of age. The distribution of injuries reported by year demonstrated that only 96 patients (36%) were
Comment
Although injury to the tracheobronchial tree is seen infrequently after blunt trauma, reports of such injuries are not new to the literature. Winslow [11] published the earliest report of an injury to the bronchus in 1871. While preparing a wild duck after a hunt, he discovered that the duck’s left main bronchus had been ruptured at the carina. The duck had survived that acute injury, apparently for several months, until “his recovery was interrupted by a hunter.” In 1873, Seuvre [5] described
Summary
Motor vehicle accidents with high-speed deceleration have become more prevalent since the 1950s and have caused the majority of tracheobronchial injuries experienced today. Both deceleration and crush injuries occur at or near the carina and most commonly involve the right main bronchus. Injury to the right bronchus or trachea predicts a worse outcome when compared with left-sided injuries. However, right bronchial and tracheal injuries are usually diagnosed within 24 hours of injury, and the
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