Management of tracheobronchial disruption resulting from blunt trauma

Delayed diagnosis of tracheobronchial disruption resulting from blunt trauma continues to cause major morbidity and death. At the University of Louisville from 1968 to 1982, 13 patients had tracheobronchial disruption resulting from blunt trauma. All injuries were caused by motor vehicle accidents. Disruptions were located in the trachea in six patients and in the right bronchus in seven patients. Physical findings included: subcutaneous emphysema (11 patients), respiratory distress (10 patients), hemoptysis (six patients), and flail chest (four patients). Four patients (30%) died, three from multiple major associated injuries and the other before therapy could be instituted. Among the nine survivors, six had immediate diagnosis and prompt surgical treatment, which consisted of suture repair in five and pneumonectomy in the other patient. Two patients had delay in diagnosis, and repair was attempted at 4 and 30 days, respectively; bronchial stricture resulted in one and pneumonectomy, empyema, and bronchopleural fistula in the other. Another patient with a bronchial mucosal tear was treated nonoperatively without complication. Tracheobronchial disruption should always be considered with massive blunt chest trauma. Repeated bronchoscopy is indicated for unexplained pleural air leaks, lobar atelectasis, or persistent pneumothorax. Prompt diagnosis and expeditious surgical therapy result in fewer complications and increased survival.