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Ann Thorac Surg 1996;61:1483-1487
© 1996 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Tracheobronchial Lacerations After Intubation and Tracheostomy

Department of Thoracic Surgery, University Hospital of Strasbourg, Strasbourg, France

Accepted for publication January 16, 1996.

	Abstract

Top Footnotes Abstract Introduction Patients and Methods Results Comment References

 
Background. Although long-term complications of intubation and tracheostomy are well documented, little has been reported on acute complications of airway access techniques.

Methods. Fourteen patients (1 male and 13 female patients) aged 15 to 80 years presented with tracheobronchial lacerations after single-lumen intubation (n = 9), double-lumen intubation (n = 1), or tracheostomy (n = 4).

Results. A left bronchial laceration after double-lumen intubation was discovered and repaired intraoperatively. A tracheal laceration after single-lumen intubation was recognized during induction of anesthesia. The remaining 12 were diagnosed within 6 to 126 hours (median, 24 hours) after injury. All patients had mediastinal and subcutaneous emphysema. At endoscopy, 12 injuries were located in the thoracic trachea and 1 in the cervical trachea. Twelve underwent primary repair through a right thoracotomy (n = 11) or left cervicotomy (n = 1), and 1 was treated conservatively. Two patients with tracheostomy injury died postoperatively. All repairs healed well but one. The latter was performed 5 days after the injury; a dehiscence occurred, but healed spontaneously.

Conclusions. We conclude that prognosis of tracheal lacerations depends both on the general health of the patient and on the rapidity of diagnosis and treatment.

	Introduction

Top Footnotes Abstract Introduction Patients and Methods Results Comment References

 
When the subject of complications after intubation or tracheostomy is put into focus, one instinctively anticipates long-term complications such as inflammatory stenoses, tracheoesophageal fistulas, and tracheo-innominate artery fistulas, which have been extensively documented in the literature [1–4]. On the other hand, there are few reports dealing with acute complications of airway access techniques. Laceration of the membranous part of the tracheobronchial tree may occur after single-lumen intubation, double-lumen intubation, and tracheostomy. Most publications address single case reports, which we have collected in a previous study [5]. Large series dealing with tracheobronchial trauma may on occasion include such patients, but little information on the mechanisms and treatment is provided [6]. The true incidence cannot be reasonably estimated, because the very large number of intubations performed daily on a worldwide basis is unknown. The fact that most publications report on a single or few case reports demonstrates the rarity of the condition. However, the frequency of injuries due to double-lumen intubation in single institutions has been estimated between 0.05% and 0.19% [7, 8].

We previously described 5 cases of tracheobronchial lacerations treated at our department [5]. The latter report led to an analysis of 12 lacerations with single-lumen tubes, and 26 lacerations with double-lumen tubes collected in the literature. The present report is based on a recently increased experience with such injuries in a single institution. The purpose of the study was to sensitize thoracic surgeons to this problem, to develop a hypothesis of genesis, and to argue for an emergency repair.

	Patients and Methods

Top Footnotes Abstract Introduction Patients and Methods Results Comment References

 
Patients
From January 1980 to June 1995, 14 patients were treated for intubation-related tracheal or bronchial lacerations. These were 13 female patients and 1 man, with a mean age of 53 ± 16 years (range, 15 to 80 years; median, 54 years). Nine injuries occurred with single-lumen tube insertion, 4 with tracheostomy, and 1 with double-lumen tube intubation.

All 9 patients with single-lumen tube injury were female, with a mean age of 50 ± 18 years (range, 15 to 80 years; median, 54 years). A common characteristic was the shortness of these patients, averaging 157 ± 5 cm (range, 148 to 165 cm; median, 158 cm). Seven had been intubated for various elective surgical procedures, whereas 2 had been intubated for respiratory distress (Table 1). All intubations had been performed by experienced staff without particular difficulties. A stylet had been used in 2 patients. Selective intubation of the right bronchus was retrospectively identified in 4.

Circumstances of Diagnosis
Diagnosis of single-lumen tube injuries was made in the recovery room or intensive care unit in 8 patients, with a mean delay of 36 ± 39 hours (range, 6 to 126 hours; median, 24 hours) (see Table 1). The diagnosis was suspected because mediastinal and subcutaneous emphysema had developed; 2 of them also had pneumothorax. Three patients were still intubated at the time of diagnosis. Two underwent computed tomographic scanning disclosing an increased tracheal diameter. The diagnosis was ascertained with fiberoptic bronchoscopy. In a final patient, the diagnosis was made during induction of anesthesia; the tube had at first selectively intubated the right main bronchus. Shortly after withdrawal, subcutaneous emphysema appeared and prompted a fiberoptic bronchoscopy, which evidenced a tracheal tear.

Tracheal tears complicating tracheostomy were recognized within 24 hours in 3 patients, owing to rapidly spreading mediastinal and subcutaneous emphysema. A final patient had at first isolated pneumoperitoneum, which misled the diagnosis during 4 days, until mediastinal emphysema occurred.

The single tear occurring with double-lumen intubation was recognized intraoperatively during esophageal resection. After removal of the operative specimen, the inflated bronchial cuff appeared in the operative field and obturated a 20-mm tear of the membranous part of the left main bronchus.

Location of the Tracheal Tear
After single-lumen intubation, 7 tears (77%) were located in the lower third of the trachea, 1 in the middle third, and 1 in the upper third. Eight tears were located at the right-side insertion of the membranosa; a single cervical tear was located in the middle of the membranosa. Five tears extended into the right main bronchus. The mean size was 4.8 ± 1.5 cm (range, 3 to 7 cm; median, 5 cm).

All tracheostomy-associated tears were located in the middle third, starting at 2 cm below the ostium of the tracheostomy, and extending for 4 to 5 cm, close to the midline of the membranosa.

Methods
Patient charts were reviewed for type of treatment, intraoperative management of ventilation, and final outcome. Quantitative data are presented as mean ± standard deviation, range, and median. Data were organized in subgroups defined by the type of intubation.

	Results

Top Footnotes Abstract Introduction Patients and Methods Results Comment References

 
Treatment
Eight patients presenting with single-lumen tube injury underwent surgical repair (89%); 7 repairs were performed through a right thoracotomy in the fourth intercostal space and 1 through a left anterior cervicotomy (Table 3). The membranosa was repaired with interrupted (n = 5) or running (n = 2) absorbable sutures. A final patient, whose diagnosis was made after a delay of 60 hours, was deliberately treated conservatively. All four tracheostomy injuries were repaired through a right-side thoracotomy. The left bronchial tear, which had been discovered intraoperatively, was sutured immediately after recognition.

Among 8 patients with single-lumen tube injury, 6 were extubated less than 12 hours after completion of surgical repair. One patient was extubated 24 hours later, and a final patient with congestive heart failure was extubated 5 days postoperatively. Only 1 of 4 tracheostomy patients was extubated the day after the procedure, all others being ventilator-dependent for associated disease.

Postoperative Results
There were two operative deaths, both in patients with tracheostomy injuries. There was one delayed tracheal healing in a patient operated on with a 5-day delay after injury. All the others healed per primam and had a satisfactory bronchoscopy 8 to 10 days after repair (Tables 3, 4).

	Comment

Top Footnotes Abstract Introduction Patients and Methods Results Comment References

At first sight, tracheal tears may be due either to traumatic maneuvers during tube insertion or to a hyperinflation of the sealing cuff. Data from the literature, and from the present series as well, indicate that most lesions are due to a hyperinflation of the cuff, which leads to a separation of the membranosa. Previously, diffusion of nitrous oxide into porous rubber cuffs has been incriminated [12], which may not occur with disposable material. Hyperinflation is unconciously caused by anesthesiologists and their nursing staff, who act with the false security of low-pressure cuffs. The most probable mechanism is as follows. At first, the tube is accidentally advanced down to the right main bronchus. Thus, the cuff is located in the relatively larger carinal space and requires large volumes to seal. Auscultation then discloses selective right ventilation, and the tube is withdrawn with insufficient deflation-or no deflation at all. As the airway caliber narrows in the lower trachea, the large volume of the cuff overstretches the membranosa, which separates, usually at the right side junction [13]. Probably, the straight line of insertion on the right side is mechanically less resistant than the angulated insertion on the left side. The same mechanism has been reported with a Sengstaken-Blakemore tube accidentally inserted into the trachea [14]. Short patients make it easy to push the tube too far down; besides, women have narrower airways. Although history of right selective intubation was found in only 4 patients in our series, the location of the lesions in the lower trachea and their extension into the right main bronchus argue in favor of this hypothesis. Direct injury with a stylet is unlikely; owing to the obliquity of the trachea, a stylet injury would be located on the anterior wall of the trachea.

Open tracheostomy has proved to be a safe method, and even with transcutaneous dilational tracheostomy, few serious complications occur [15]. The safety of the latter technique may be increased with bronchoscopic guidance [16]. Direct trauma during placement of the cannula, perhaps favored by kyphoscoliosis and inexperience, is the usual mechanism.

Lacerations with double-lumen catheters again are due to overinflation of the cuffs. Tracheal lacerations regularly measure 4 cm and bronchial tears 2 cm, as do the tracheal and bronchial cuffs, respectively [7]. Patient positioning with inflated cuffs may be a contributive factor [8]. Most of the lesions (88%) are discovered intraoperatively, because of impaired ventilation or mediastinal emphysema. Forty percent are located in the lower trachea and 62.5% in the main bronchus; combined lacerations are encountered in 2.5% [5].

Mediastinal and subcutaneous emphysema appearing in the recovery room during retching and cough, or in a still-ventilated patient, should be suggestive enough to trigger adequate investigations. Although peripheral alveolar rupture may be a differential diagnosis [17], fiberoptic endoscopy is mandatory. Massive air leaks may burst the mediastinal pleura and cause pneumothorax; the rupture pressure has been experimentally determined at about 20 mm Hg [18]. In exceptional cases the air escapes toward the retroperitoneum or peritoneal cavity, and initial symptoms may be misleading [19].

Specific radiologic signs herald tracheal disruption. A large air leak may determine a paratracheal bulla [20]. Deviation of the tip of the endotracheal tube to the right on plain chest films should cause suspicion because most ruptures occur on the right side [21]. On computed tomographic scans, a tracheal tear should be suspected whenever the diameter of the cuff exceeds 2.8 cm, because the mean tracheal caliber is 2.0 cm in female patients and 2.4 cm in male patients [22].

Although emergency repair is the indication of common sense, some tears may heal with conservative management provided that the patient's symptoms do not increase and the tear is short and does not gape during respiratory air flow [23]. On the other hand, early repair in healthy tissues is a guarantee of satisfactory results [5]. The only suture dehiscence we observed occurred in a delayed repair.

The surgical approach is determined by the location of the tear: left cervicotomy for the cervical trachea, right thoracotomy in the fourth intercostal space for the thoracic part. We have no experience with left cervicotomy and sternal split for lower tracheal lesions [24] or with the transcervical-transtracheal approach [25]. The repair is naturally covered with the esophagus while the mediastinal pleura is reapproximated. Additional cover may be required when tissues are inflammatory or when early extubation is impossible; a recent review has summarized the various flaps that may be used [26]. Intraoperative ventilation may be critical in the case of lower tracheal tears. We recommend proximal intubation with the cuff located immediately below the vocal cords to avoid further tracheal trauma. Once the leak is exposed, it is usually possible in short patients to advance the tube to the left main bronchus and to obtain both air-tight ventilation and left single-lung ventilation. However, intermittent packing or manual occlusion, alternating with sutures, is a valuable alternative. Jet ventilation is not always accessible in emergency conditions, and may be cumbersome to surgeons who are not familiar with this technique.

Immediate postoperative results usually are satisfactory, and therefore emergency repair of tracheal tears should be the rule. Vital prognosis depends more on the underlying disease than on the injury itself.

	Footnotes

Top Footnotes Abstract Introduction Patients and Methods Results Comment References

 
Address reprint requests to Dr Massard, Department of Thoracic Surgery, University Hospital of Strasbourg, 1, place de l'Hôpital, F-67091 Strasbourg, France.

	References

Top Footnotes Abstract Introduction Patients and Methods Results Comment References

 

1. Grillo HC, Donahue DM, Mathisen DJ, Wright CD. Postintubation tracheal stenosis. Treatment and results. J Thorac Cardiovasc Surg 1995;109:486–92.[Abstract/Free Full Text]
2. Wood DE, Mathisen DJ. Late complications of tracheotomy. Clin Chest Med 1991;12:597–609.[Medline]
3. Mathisen DJ, Grillo HC, Wain JC, Hilgenberg AD. Management of acquired nonmalignant tracheoesophageal fistula. Ann Thorac Surg 1991;52:759–65.[Abstract]
4. Gelman JJ, Aro M, Weiss SM. Tracheo-innominate artery fistula. JAMA 1994;179:626–34.
5. Massard G, Wihlm JM, Roeslin N, et al. Plaies trachéobronchiques iatrogènes au cours de l'intubation. J Chir (Paris) 1992;129:297–302.
6. Velly JF, Martigne C, Moreau JM, Dubrez J, Kerdi S, Couraud L. Posttraumatic tracheobronchial lesions. A follow-up study of 47 cases. Eur J Cardiothorac Surg 1991;5:356–62.[Abstract]
7. Guernelli N, Bragaglia RB, Bricoli A. Tracheobronchial ruptures due to cuffed Carlens tubes. Ann Thorac Surg 1979;28:66–8.[Abstract]
8. Lafont D, Dartevelle P, Noviant Y. Déchirure trachéale après intubation par sonde de Carlens. Anesth Analg Réan 1981;38:259–63.
9. De Saint Florent G. Rupture trachéale étendue après intubation. Nouv Presse Med 1979;8:2287.
10. Foster JMG, Lau OJ, Alimo EB. Ruptured bronchus following endobronchial intubation. Br J Anaesth 1983;55:687–8.[Abstract/Free Full Text]
11. Epstein SK, Gottlieb DJ, Faling LJ. Bronchial stump disruption following inadvertent right mainstem intubation 9 years after pneumonectomy. Am J Emerg Med 1993;11:47–50.[Medline]
12. Mehta S. Effects of nitrous oxide and oxygen on tracheal cuff gas volumes. Br J Anesth 1981;53:1277–9.[Abstract/Free Full Text]
13. Thompson DS, Read RC. Rupture of the trachea following endotracheal intubation. JAMA 1968;204:995–7.[Abstract/Free Full Text]
14. Thomas P, Auge A, Lonjon T, Perrin G, Giudicelli R, Fuentes P. Rupture of the thoracic trachea with a Sengstaken-Blakemore tube. J Cardiovasc Surg 1994;35:351–3.[Medline]
15. Toursarkassian B, Zweng TN, Kearney PA, Pofahl WE, Johnson SB, Barker DE. Percutaneous dilational tracheostomy: report of 141 cases. Ann Thorac Surg 1994;57:862–7.[Abstract]
16. Marelli D, Paul A, Manolidis S, et al. Endoscopic guided percutaneous tracheostomy: early results of a consecutive trial. J Trauma 1990;30:433–5.[Medline]
17. Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema. Arch Intern Med 1984;144:1447–53.[Abstract/Free Full Text]
18. Webb WR, Johnston JH, Geisler JW. Pneumomediastinum: physiologic observations. J Thorac Surg 1958;35:309–15.
19. Barnhart GR, Brooks JW, Kellum JM. Pneumoperitoneum resulting from tracheal rupture following blunt chest trauma. J Trauma 1986;26:486–8.[Medline]
20. Bricard H, Sillard B, Leroy G, Segol P, Gignoux M. Rupture trachéale après intubation par sonde de Carlens. Ann Chir 1979;33:238–41.[Medline]
21. Rollins RJ, Tocino I. Early radiographic signs of tracheal rupture. Am J Radiol 1987;148:695–8.[Abstract/Free Full Text]
22. Kahn F, Reddy NC. Enlarging intratracheal tube cuff diameter: a quantitative roentgenographic study of its value in the early prediction of serious tracheal damage. Ann Thorac Surg 1977;24:49–53.[Abstract]
23. Bonniot JP, Even PH. Rupture trachéale partielle après intubation: abstention chirurgicale et surveillance endoscopique. Presse Méd 1979;8:781.
24. Gorenstein LA, Abel JG, Patterson GA. Pericardial repair of a tracheal laceration during transhiatal esophagectomy. Ann Thorac Surg 1992;54:784–6.[Abstract]
25. Angelillo-Mackinlay T. Transcervical repair of distal membranous tracheal laceration. Ann Thorac Surg 1995;59:531–2.[Abstract/Free Full Text]
26. Anderson TM, Miller JI Jr. Use of pleura, azygos vein, pericardium, and muscle flaps in tracheobronchial surgery. Ann Thorac Surg 1995;60:729–33.[Abstract/Free Full Text]

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This Article Abstract Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Gilbert Massard Norbert Roeslin Jean-Marie Wihlm Georges Morand Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Massard, G. Articles by Morand, G. Search for Related Content PubMed PubMed Citation Articles by Massard, G. Articles by Morand, G.