Traumatic tracheal laceration in a pediatric patient medically managed with high-frequency oscillatory ventilation

A 12-year-old boy presented to the emergency department in respiratory failure with massive subcutaneous emphysema extending from his head to his thighs. This resulted after he fell onto an industrial trash receptacle (dumpster) striking his right lateral neck. Airway management was obtained through an oral endotracheal tube in the emergency department. Initial scans revealed massive subcutaneous emphysema and pockets of anterior air suggestive of a tracheal tear. The patient was conservatively managed without surgical repair using high-frequency oscillatory ventilation through an oral endotracheal tube. Injuries to the trachea are exceedingly rare in the pediatric population. These patients have a high morbidity and mortality likely due to delay in proper diagnosis of this injury. Historically, these patients have been treated with surgical correction of the injury. Management of tracheal tears without surgical intervention may be possible if the endotracheal tube is able to stent the wound and allow for wound healing.