[Iatrogenic injuries of the trachea]

As a basis for quality assurance measures, we analysed over a period of three years all iatrogenic tracheobronchial injuries that had to be repaired operatively at a university hospital. Twelve patients were affected. In most of these cases, the injuries were the result of an intubation during resuscitation attempts prior to or after admission to hospital (6 patients; 4 of them died later). The ruptures of 5 patients were due to complications of a dilational tracheostomy (1 died). In one case the laceration occurred in the course of a reoperation after oesophagectomy (conservative treatment after dehiscence of the tracheal suture). The tracheobronchial ruptures (length: 2 to 8 cm) were located in the pars membranacea and had surgical repair through a thoracotomy on the right side. During the period of this investigation, 43,773 elective intubations were performed. No such serious tracheal injuries were observed. The cause of death in the patients with tracheal injuries was mainly the underlying disease (resuscitation after myocardial infarction; tracheostomy because of pulmonary failure in septic disorders); however, it is likely that the injuries or the surgical intervention played an additional role in the negative outcome of the patients. The conclusion is that this complication rate must be reduced by in-service training and alteration of the procedures.