Surgical treatment of patients with ruptures of the trachea

Abstract

BACKGROUND: Currently, the incidence of iatrogenic ruptures of the trachea averages 0.02–0.07% with elective tracheostomy and intubation, but in the event of an emergency procedure, this figure rises to 15%. The feasibility and validity of the use of one or another method of treating tracheal injuries is the subject of discussion among the authors of scientific studies and specialists. There is no single generally accepted method of treatment that would be effective for various types and degrees of damage to the tracheal wall.

AIM: to determine the indications for various types of surgical intervention based on the analysis of the results of treatment of patients with tracheal ruptures.

MATERIALS AND METHODS: The study included 10 patients with iatrogenic tracheal ruptures. All patients underwent a comprehensive diagnosis using physical, laboratory, radiation and instrumental methods of research, as well as an analysis of the effectiveness of various methods of treating tracheal rupture, depending on the nature of the injury.

RESULTS: Patients with grade 1 and 2 tracheal injury with no or uncomplicated gas syndrome are treated conservatively. In patients with grade 2 tracheal injury and progressive gas syndrome, tracheostomy and mediastinal drainage are effective. With ruptures to the entire depth of the wall (3A and 3B degrees), surgical intervention with suturing of the trachea is indicated. In the case of functional inoperability of a patient with severe tracheal ruptures, one of the effective treatment options is the use of extracorporeal membrane oxygenation in combination with minimally invasive drainage interventions.

CONCLUSION: indications for various methods of treatment of patients with tracheal ruptures have been formulated. The developed management algorithm is used in providing care to patients with tracheal injury in hospitals of the S.M. Kirov Military Medical Academy.

Keywords

extracorporeal membrane oxygenation / fibrobronchoscopy / iatrogenic injury / intubation / minimally invasive surgery / tracheal rupture / tracheostomy

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Tishchenko E.A., Fufayev E.E., Barinov O.V.