Fiberoptic bronchoscopy in the evaluation of acute chest and upper airway trauma

To determine the utility of fiberoptic bronchoscopy (FFB) in the short-term evaluation of patients with trauma, we identified 53 consecutive patients (45 male patients; mean age, 36 years) seen over a ten-year period who had FFB performed within the first three days of trauma to the chest and upper airway. There were eight deaths. Fifty patients had blunt trauma to the chest. These were mostly due to motor vehicle accidents (38 patients), crushing injuries (three patients), and falls (three patients). In addition, there were three patients with trauma to the neck. Physical and radiographic findings included pneumothorax (37 patients), subcutaneous emphysema (31), pulmonary contusion (22), hemothorax (21), mediastinal emphysema (16), flail chest (ten), atelectasis (ten), and hemoptysis (five). The FFB was of diagnostic use in 28 patients (53 percent) by revealing complete tracheal transection (one patient), tracheal laceration (three), complete bronchial transection (one), bronchial laceration (two), bronchial contusion (two), ongoing distal hemorrhage/pulmonary contusion (seven), aspirated material (three), mucous plugging/thick secretions (eight), and supraglottic lesions (three). One of the cases of tracheal laceration was not fully appreciated as a complete transection. We conclude that FFB has value in the short-term evaluation of patients with trauma.