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Traumatic tracheal injury in children: a case series supporting conservative management
Joshua W Wood1, Blakely Thornton1, C Scott Brown1
1University of Tennessee Health Science Center, Department of Otolaryngology-Head & Neck Surgery, Memphis, TN, United States.
Insights
Conservative management for pediatric tracheobronchial injuries, often caused by endotracheal intubation, is effective. This approach avoided open surgery in most cases, though some children developed tracheal stenosis requiring further intervention.
Area of Science:
- Pediatric Otolaryngology
- Trauma Surgery
- Respiratory Medicine
Background:
- Non-penetrating tracheobronchial injuries are rare but life-threatening.
- Causes include blunt trauma and iatrogenic factors like endotracheal intubation.
- Treatment consensus is lacking, with evolving evidence for conservative approaches.
Purpose of the Study:
- To report outcomes of conservative treatment for pediatric non-penetrating tracheobronchial injuries.
- To evaluate the efficacy of conservative management in avoiding open surgery.
- To provide evidence supporting conservative therapy in this patient population.
Main Methods:
- Retrospective review of 8 pediatric patients treated by Otolaryngology from May 2012 to March 2014.
- Inclusion criteria: non-penetrating tracheobronchial injury.
- Data collected: injury type, endoscopic findings, treatment, and follow-up.
Main Results:
- Mean age 9.25 years; 6/8 injuries related to endotracheal intubation.
- All patients underwent diagnostic laryngoscopy/bronchoscopy and initial conservative management.
- All injuries healed without immediate open surgery; 62.5% developed tracheal stenosis, 37.5% required further procedures (tracheostomy, balloon dilation).
Conclusions:
- This case series is the largest on conservative treatment for pediatric traumatic tracheal injuries.
- Initial conservative therapy successfully avoided open surgical procedures in most patients.
- Findings support conservative management as a primary approach for children with tracheobronchial injuries.
Objectives:
Injuries to the tracheobronchial region are rare, but have the potential for rapid progression and can become life-threatening. Etiologies of non-penetrating tracheobronchial injuries include blunt cervical trauma, endotracheal intubation, and other iatrogenic causes. Several options for treatment ranging from conservative to surgical exist, but no single treatment has been implemented with consensus. While early surgical repair was once considered the cornerstone of therapy, evidence supporting conservative treatment continues to gain strength.
Methods:
All pediatric patients who suffered from non-penetrating injuries to the tracheobronchial tree who were treated by the Otolaryngology Service at a tertiary children's hospital from May 2012 through March 2014 were recorded. A total of 8 patients were identified. The cases were collected from the patients treated by the Otolaryngology Department based on retrospective review. The available electronic medical records were reviewed for each patient. Data including type of injury, endoscopic assessment of injury, treatment received, and follow-up were collected.
Results:
The ages ranged from 2 to 15 years old, with a mean of 9.25 years old. Six of the eight patients had injuries related to endotracheal intubation. Each patient was taken to the operating suite for diagnostic direct laryngoscopy and bronchoscopy, and treated with initial conservative management. All but one of the patients was treated with endotracheal intubation, and the average length of intubation was 11.71 days. All of the injuries healed spontaneously without requiring initial open surgery. Five patients (62.5%) developed some degree of tracheal stenosis. Three patients (37.5%) required further surgery; one received a tracheostomy and two patients required balloon dilation.
Conclusions:
This case series is the largest to date documenting the outcomes of conservative treatment of non-penetrating traumatic tracheal injuries in children. By using initial conservative therapy, we were able to avoid open surgical procedures in many of our patients. We believe that this case series provides further support for conservative management for children with tracheobronchial injuries.
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