Management of Tracheobronchial Injuries

Tracheobronchial injuries encompass a spectrum of airway disruptions arising from blunt or penetrating trauma, iatrogenic procedures and, rarely, spontaneous rupture. Initial management hinges on rapid airway assessment with a high index of suspicion in patients presenting with subcutaneous emphysema, persistent air leak or respiratory distress. Flexible bronchoscopy remains the diagnostic cornerstone, often complemented by high-resolution computed tomography with three-dimensional reconstruction to delineate lesion extent and guide therapy. Definitive treatment may be surgical or conservative. Small, contained tears in stable patients can be managed non-operatively under close surveillance, whereas larger full-thickness lacerations, airway obstruction or mediastinitis necessitate prompt surgical repair. Surgical options include direct suture, segmental resection with end-to-end anastomosis or more complex reconstructions. Perioperative care requires meticulous ventilatory strategies, vigilant infection control and, where indicated, extracorporeal support to optimise oxygenation and carbon dioxide removal. Long-term outcomes depend on early intervention, injury location and the presence of associated thoracic trauma.

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Management of Tracheobronchial Injuries publication trend

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Technical terms

Iatrogenic tracheobronchial rupture: Full-thickness airway tear caused by medical procedures such as intubation or tracheostomy.

Bronchoscopy: Endoscopic examination of the trachea and bronchi for direct visualisation and intervention.

End-to-end anastomosis: Surgical reconnection of airway segments after resection of the injured portion.

Extracorporeal membrane oxygenation (ECMO): External circuit providing cardiac and respiratory support by oxygenating and circulating blood outside the body.

Posterolateral thoracotomy: Surgical access to the thoracic cavity via an incision along the back and side of the chest wall.

References

1. Management of Tracheobronchial Injuries. Eurasian Journal of Medicine (2014).
2. Prognostic Factors for Iatrogenic Tracheal Rupture: A Single-Center Retrospective Cohort Study. Journal of Clinical Medicine (2020).
3. Bronchial rupture following endobronchial blocker placement: a case report of a rare, unfortunate complication. BMC Anesthesiology (2021).
4. Cervical Repair of Iatrogenic Tracheobronchial Injury by Tracheal T-Incision. The Annals of Thoracic Surgery (2022).