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Ann Thorac Surg 1999;68:1124
© 1999 The Society of Thoracic Surgeons

Correspondence

Reply

Jean-Paul d’Odemont, MDa, Daniel O.A. Rodenstein, MDb

a Service de Pneumologie, Clinique Saint-Joseph, Av Baudouin de Constantinople 5, 7000 Mons, Belgium
b Thoracic Division, Cliniques Universitaires St Luc, Av Hippocrate 10, 1200 Brussels, Belgium

To the Editor

We have read with interest the comments reported by Nazari a associates concerning the management of tracheo-bronchial laceration limited to the membranous part. The authors attribute their favorable results to tracheostomy, which would prevent deletereous increases in intratracheal pressure during activities like coughing. We would like to point out that the presence of a tracheostomy does not constitute a proof of its usefulness. Indeed, our group [1] and others [2] have reported similar favorable outcomes with simpler medical management without tracheostomy. Moreover, coughing is preserved in tracheostomized patients, and when one sees the velocity of secretions coming out from a tracheostomy tube, it is at least doubtful that intrathoracic pressures are much reduced. Because tracheostomy has its own complications [3], and because its exact role in determining the outcomes in tracheal laceration is still doubtful, we believe a more conservative and cautious approach is still warranted.

References

  1. D’Odemont J.P., Pringot J., Goncette L., Goenen M., Rodenstein D. Spontaneous favorable outcome of tracheal laceration. Chest 1991;99:1290-1292.[Abstract/Free Full Text]
  2. Velly J.F., Martigne C., Moreau J.M., Dubrez J., Kerdi S., Couraud L. Post-traumatic tracheobronchial lesions. A follow-up study of 47 cases. Eur J Cardiothorac Surg 1991;5:352-355.[Abstract]
  3. Stock M.C., Woodward C.G., Shapira B.A., et al. Perioperative complications of elective tracheotomy in critically ill patients. Crit Care Med 1986;14:861-863.[Medline]

Related Article

Decompressing tracheostomy for the treatment of postintubation tracheal rupture
Stefano Nazari, Paolo Buniva, Alessandro Aluffi, Susanna Salvi, and Ziad Mourad
Ann. Thorac. Surg. 1999 68: 1122-1124. [Extract] [Full Text] [PDF]




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