Iatrogenic tracheobronchial perforation in infants

Area of Science:

• Pediatric critical care
• Neonatology
• Medical device complications

Background:

• Endotracheal tube (ETT) placement is a common procedure in neonates.
• Iatrogenic tracheobronchial perforation is a rare but life-threatening complication.
• Premature infants are particularly vulnerable due to their delicate airway anatomy.

Purpose of the Study:

• To describe the clinical and radiographic features of acute iatrogenic tracheobronchial perforation in premature infants.
• To highlight the importance of early recognition and prompt management.
• To review previously reported cases and assess overall mortality.

Main Methods:

• Retrospective review of four premature infants with confirmed tracheobronchial perforation.
• Analysis of clinical presentation, intubation details, and radiographic findings.
• Comparison with eight previously reported cases.

Main Results:

• Four cases of iatrogenic tracheobronchial perforation due to ETT malposition were identified.
• Radiographic findings included inferior ETT malposition, decreased pulmonary aeration, and pneumomediastinum.
• Two infants died despite aggressive management; two survived with conservative care.
• Overall mortality in reported cases is 58%.

Conclusions:

• Acute iatrogenic tracheobronchial perforation is a significant risk in premature infants undergoing intubation.
• Subtle radiographic signs, including infraazygos pneumomediastinum, should raise suspicion.
• Prompt recognition and appropriate management are critical for improving outcomes and potentially saving lives.