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(Chest. 2006;130:412-418.)
© 2006 American College of Chest Physicians

Management of Postintubation Tracheobronchial Ruptures*

Massimo Conti, MD; Marie Pougeoise, MD; Alain Wurtz, MD; Henri Porte, MD, PhD; François Fourrier, MD, FCCP; Philippe Ramon, MD and Charles-Hugo Marquette, MD, PhD

* From the Clinique de Chirurgie Thoracique (Drs. Conti, Wurtz, and Porte), Clinique d’Anesthésie Cardio-Thoracique (Dr. Pougeoise), Service de Réanimation Polyvalente (Dr. Fourrier), and Clinique des Maladies Respiratoires (Drs. Marquette and Ramon), CHRU Lille, Lille, France.

Correspondence to: Charles-Hugo Marquette, Clinique des Maladies Respiratoires, Hôpital Albert Calmette, CHRU de Lille, 59037 Lille cedex, France; e-mail: c-marquette{at}chru-lille.fr

Abstract

Study objectives: To determine whether nonoperative management can be applied to iatrogenic postintubation tracheobronchial rupture (TBR).

Design: Prospective cohort study.

Patients and interventions: Thirty consecutive patients with TBR complicating intubation between June 1993 and December 2005 entered the study. Patients not receiving mechanical ventilation at time of diagnosis were treated nonsurgically. Patients receiving mechanical ventilation who were judged operable underwent surgical repair, while nonoperable candidates had their TBR bridged by endotracheal tubes.

Results: Fifteen patients not requiring mechanical ventilation underwent simple conservative management. TBR length measured 3.85 ± 1.46 cm (mean ± SD). Eight TBRs showed full-thickness rupture with frank anterior intraluminal protrusion of the esophagus. In three patients, transient noninvasive positive pressure ventilatory support (NIV) was necessary. All lesions healed without sequelae. Two patients receiving mechanical ventilation underwent surgical repair and died. Thirteen patients receiving mechanical ventilation were considered at high surgical risk, and TBR bridging was attempted as salvage therapy. Complete bridging was achieved in five patients by simply advancing the endotracheal tube distal to the injury. Separate bilateral mainstem endobronchial intubation was necessary in six patients whose TBRs were too close to the carina. Nine of 13 patients (69%) treated with nonoperative therapy completely recovered.

Conclusion: We conclude that conservative nonoperative therapy should be considered in patients with postintubation TBR who are breathing spontaneously, or when extubation is scheduled within 24 h from the time of diagnosis, or when continued ventilation is required to treat an underlying respiratory status. Surgical repair should be reserved for cases in which NIV or bridging the lesion is technically not feasible.

Key Words: injury • intubation • mechanical ventilation • rupture • surgery • trachea






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