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J Thorac Cardiovasc Surg 2008;136:782-783
© 2008 The American Association for Thoracic Surgery

Brief Communication

Nonoperative management of large tracheal injuries

Department of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University, St Louis, Mo

Received for publication September 20, 2007; accepted for publication December 7, 2007.

^_* Address for reprints: Daniel Kreisel, MD, PhD, Division of Cardiothoracic Surgery, Campus Box 8234, 660 South Euclid Avenue, St Louis, MO 63110-1013. (Email: kreiseld@wudosis.wustl.edu).

The first 20% of the full text of this article appears below.

Tracheobronchial injuries occur rarely as the result of trauma or iatrogenically from airway intubation. Classic surgical teaching mandates prompt diagnosis and surgical repair. More recently, however, support for nonoperative management of tracheal injuries in selected patients has been established. We present 2 cases of large iatrogenic tracheal injuries managed successfully without operative intervention and with excellent clinical outcomes.

Clinical Summary

Case 1
A 29-year-old woman was strangulated and subsequently rescued by the emergency medical service, who performed orotracheal intubation at the scene. On evaluation in the emergency department she was found to have a pneumomediastinum, and an aerodigestive tract injury was suspected. A membranous 5-cm tracheal laceration was identified by bronchoscopy that extended from the mid-trachea to the orifice of the left mainstem bronchus ( Figure 1, A). Nonoperative management was chosen because the patient had no clinical evidence of mediastinitis and a chest computed tomography scan did not demonstrate any significant mediastinal fluid collection. After 9 days of observation and intravenously . . . [Full Text of this Article]

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