Artikel
Conservative treatment of post-intubation tracheal tears – report of four cases
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Veröffentlicht: | 4. April 2012 |
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Introduction: Latrogenic tracheal rupture is a rare but potentially lethal complication after intubation. Cases in the field of otolaryngology have only occasionally been reported.
Methods: We present four patients with tracheal tears. In all of these patients, a common finding was a lesion of the posterior tracheal wall. Operations performed were microlaryngoscopy, voice prosthesis implantation, subtotal parotidectomy with ipsilateral neck dissection and panendoscopy. In all patients, the first clinical sign of the rupture was postoperative subcutaneous emphysema. Diagnosis and follow-up were based on tracheoscopy and chest CT scans. Our treatment protocol consisted of surgical tracheotomy, collar incisions, drainage, and broad-band antibiotic therapy. Closure of tracheostomas was scheduled for 1–2 months after tracheal injury. In one laryngectomized patient, we bridged the lesion with a cuffed endotracheal tube.
Results: No mediastinitis occurred and all patients survived without sequelae.
Conclusions: In clinically stable patients with spontaneous breathing and with no mediastinitis, a conservative treatment of tracheal tears is a safe procedure. In cases with progressive subcutaneous/mediastinal emphysema or dyspnea, we suggest tracheotomy and bypassing the lesion with a tracheostomy tube to avoid an increase in air leakage into the mediastinum. Patients having a tracheal tear and mediastinitis should be treated surgically.