Successful Conservative Treatment of Tracheobronchial Injury as a Complication After Emergency Tracheal Intubation in...

BACKGROUND Tracheal intubation is a routine but potentially hazardous procedure, with complications ranging from mild mucosal injury to severe tracheobronchial trauma. Tracheobronchial injuries are particularly critical, with high morbidity and mortality rates, necessitating prompt diagnosis and appropriate management. However, there is no clear consensus on optimal treatment, especially in pediatric patients. CASE REPORT We present a case of a previously healthy 11-month-old girl who developed a tracheobronchial injury following endotracheal intubation for status epilepticus. Computed tomography (CT) revealed a 6×4 mm tracheobronchial injury, left pneumothorax, and mediastinal emphysema. Given the minor nature of the injury, stable respiratory status, and the expectation of early extubation, conservative management was selected. The patient was treated with nasal intubation, antibacterial therapy, and close monitoring. She was successfully extubated on the second day and discharged on the tenth day without complications. CONCLUSIONS This case highlights the importance of recognizing tracheobronchial injury as a potential intubation-related complication, especially in infants with fragile airway anatomy. Key factors contributing to the injury included deep tube insertion, inappropriate tube size, and elevated cuff pressure. Our experience suggests that conservative management can be a viable option in select cases of pediatric tracheobronchial injury when symptoms are minimal and early extubation is feasible. Additionally, meticulous intubation techniques, proper tube selection, and experienced personnel are critical in preventing such complications. Further studies are needed to establish standardized guidelines for managing tracheobronchial injuries in infants and young children.