[Tracheal rupture: delayed diagnosis with endobronchial intubation]

Area of Science:

• Emergency Medicine
• Anesthesiology
• Trauma Surgery

Background:

• Tracheobronchial rupture is a rare but serious complication associated with endotracheal intubation.
• Iatrogenic tracheal laceration can be obscured by incorrect endotracheal tube (ETT) positioning.
• Preclinical intubation in trauma patients presents unique challenges for airway management.

Observation:

• Iatrogenic tracheal laceration occurred during intubation, initially masked by the endobronchial tube's deep placement.
• Ventilation was inadvertently maintained via the tube's lumen and Murphy's eye, concealing the injury.
• Upon repositioning the tube after chest X-ray, the tracheal laceration was revealed, causing immediate ventilation difficulties.

Findings:

• The deep intubation, a complication itself, paradoxically protected the patient by maintaining ventilation despite the tracheal laceration.
• Prompt recognition and management, including fiberoptic-guided tube replacement and jet ventilation, were crucial.

Implications:

• This case highlights the critical importance of verifying endotracheal tube placement and recognizing potential complications.
• It underscores how unexpected tube positioning can sometimes mitigate immediate life-threatening consequences of other iatrogenic injuries.
• The management strategy, including surgical repair and specialized ventilation techniques, offers insights for similar rare trauma cases.