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Membranous tracheal rupture after endotracheal intubation
C H Marty-Ané1, E Picard, O Jonquet
1Service de Chirurgie Thoracique, Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire, Montpellier, France.
Background:
Tracheobronchial rupture after tracheal intubation has been infrequently reported. We report 6 cases of membranous tracheal rupture after endotracheal intubation treated at our institution over 7 years.
Methods:
Overinflation of the tracheal cuff was speculated to be a frequent cause of the tracheal damage because the lesion was always a linear laceration of the posterior membranous wall. The diagnosis was suspected on the basis of common signs such as subcutaneous emphysema, respiratory distress, pneumomediastinum, and pneumothorax. Fiberoptic bronchoscopy was the best means of confirming the diagnosis and determining the location and extent of the lesion. In 5 patients, extensive laceration with severe respiratory disorders required emergent repair through a right posterolateral thoracotomy.
Results:
There were two postoperative deaths unrelated to the tracheal lesion. A patient with a small tracheal defect and favorable clinical presentation showed a rapid positive outcome after conservative treatment.
Conclusions:
Tracheal intubation-related airway ruptures are rare but probably underestimated. Early recognition and emergent repair are essential, because failure to do so could result in potentially lethal events.