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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Laureano Molins Michael E. Burt Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Molins, L. Articles by Burt, M. E. Search for Related Content PubMed Articles by Molins, L. Articles by Burt, M. E.

Ann Thorac Surg 1997;64:1227-1228
© 1997 The Society of Thoracic Surgeons

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Correspondence

Conservative Treatment of Tracheal Lacerations Secondary to Endotracheal Intubation

Thoracic Surgery Service, Hospital Sagrado Corazón, Barcelona 08029, Spain

To the Editor:

We have read with great interest the report by Ross and associates [1] concerning nonoperative management of tracheal laceration after endotracheal intubation.

We have recently published [2] a case report of 2 female patients admitted to our hospital for elective operations, 1 for bilary disease and the other for vascular disease. Shortly after operation and single-lumen endotracheal intubation without difficulty, both presented subcutaneous emphysema and pneumomediastinum without pneumothorax, a clinical picture attributable to tracheal laceration. Bronchoscopic examination revealed a linear tear of 2.5 and 4.5 cm, respectively, in the membranous part of the middle trachea. After evaluation of stable patient status, conservative medical treatment was prescribed in both patients, with no progression of subcutaneous emphysema or pneumomediastinum in the following days. Outcome was excellent without complications, and a 2-month bronchoscopic control revealed the lesions to be completely healed, with a little granuloma in 1 patient that disappeared in a subsequent control.

In our patients a single-lumen 8-mm endobronchial tube was placed without apparent difficulty, so the cause of the injury is not evident. We suggest that a little cough in a patient with moderate sedation at the time of the intubation is the easiest way to cause a linear longitudinal tear in the posterior membranous part of the trachea.

In our report [2], a review of 32 cases of tracheal laceration after intubation showed that 28 (87.5%) were repaired surgically with a mortality of 17.8%. The other 4 patients treated conservatively and our 2 patients survived, as Ross and associates' patient did.

Our and others' [3–5] experience support the criteria to be used as guidelines in deciding on nonoperative management of intubation-related tracheal lacerations proposed by Ross and associates [1]: a stable patient with no difficulty ventilating or without respiratory distress if extubated, with minimal mediastinal fluid collection and no evidence of esophageal injury, signs of sepsis, or progression of pneumomediastinum or subcutaneous emphysema.

References

1. Ross HM, Grant FJ, Wilson RS, Burt ME. Nonoperative management of tracheal laceration during endotracheal intubation. Ann Thorac Surg 1997;63:240–2.
2. Buitrago LJ, Molins L, Boada JE, Sopeña JJ, Vidal G. Tratamiento conservador en dos lesiones traqueales secundarias a intubación anestésica. Arch Bronconeumol 1997;33:151–3.
3. Varela G, Jimenez M. Rotura traqueal secundaria a intubación o traqueostomía. Arch Bronconeumol 1993;31:421–3.
4. Van Klarenbosch J, Meyer J, De Lange JJ. Tracheal rupture after tracheal intubation. Br J Anaesth 1994;73:550–1.
5. Regragui JA, Fagan AM, Natrajan KM. Tracheal rupture after tracheal intubation. Br J Anaesth 1994;72:705–6.

Reply

Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021

To the Editor:

My colleagues and I thank Drs Molins, Buitrago, and Vidal for their comments. We agree with their conclusion that in selected patients nonoperative management of intubation-related tracheal lacerations is indicated. We are glad that they agree with our guidelines in deciding on nonoperative management, which include:

1. Stable vital signs.
   
2. No difficulty ventilating the patient while intubated or respiratory distress while extubated.
   
3. No evidence of esophageal injury.
   
4. Minimal mediastinal fluid collection.
   
5. Nonprogressive pneumomediastinum or subcutaneous emphysema
   
6. No signs of sepsis.
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Laureano Molins Michael E. Burt Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Molins, L. Articles by Burt, M. E. Search for Related Content PubMed Articles by Molins, L. Articles by Burt, M. E.