Severe Tracheobronchial Injuries: Our Experience
| Autor: | Jose Luis Encinas, Juan A. Tovar, Juan José Vázquez, Carlos De La Torre, Ruben Ortiz, E Domínguez, Alejandra Vilanova Sanchez, Ane M. Andres Moreno, Francisco Hernandez, Manuel Lopez Santamaria |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment Fistula Bronchi Neck Injuries Bronchoscopy Intubation Intratracheal medicine Extracorporeal membrane oxygenation Humans Intubation Child Retrospective Studies Mechanical ventilation medicine.diagnostic_test business.industry Arterial Embolization Retrospective cohort study Lung Injury medicine.disease Combined Modality Therapy Respiration Artificial Surgery Trachea Treatment Outcome Esophagectomy Child Preschool Anesthesia Pediatrics Perinatology and Child Health Drainage Female business |
| Zdroj: | European Journal of Pediatric Surgery. 25:71-76 |
| ISSN: | 1439-359X 0939-7248 |
| DOI: | 10.1055/s-0034-1386642 |
| Popis: | Introduction Severe tracheobronchial injuries (TBI) in children are usually traumatic or iatrogenic. However, they can also be caused by mediastinal infections that lead to critical situations. We herein report our experience in the treatment of these lesions. Methods A retrospective study was conducted for patients treated at our center from 2008 to 2014. TBI was diagnosed by imaging studies and bronchoscopy. Treatment was initially conservative (drainage of air and secretions, mechanical ventilation with minimal pressures, and an early extubation) with a limited use of surgical procedures whenever necessary. Results A total of 10 patients (7 males and 3 females) with a median age of 7.5 years (range, 3–17 years) suffered TBI. The mechanism was traumatic in six (three accidental and three iatrogenic) and mediastinal infection in four (three mycotic and one bacterial abscesses). All traumatic cases responded to conservative measures, except one iatrogenic lesion, which was surgically repaired. There were no complications or residual damages. Two patients with mediastinal infection presented with sudden cardiorespiratory arrest, one with hemoptysis caused by an arteriotracheal fistula and the other because of carinal rupture. Both died before any therapeutic measures could be taken. The other two patients were treated, one with previous extracorporeal membrane oxygenation support, underwent arterial embolization, but ultimately died, and the other one survived, but required esophagectomy and creation of a thoracostome for secondary wound closure of the bronchocutaneous fistula. Conclusion Conservative treatment with gentle respiratory support suffices in most traumatic cases of TBI. Infectious abscesses with involvement of adjacent structures sometimes require complex surgery and are life-threatening. |
| Databáze: | OpenAIRE |
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