Ruptura iatrogénica da traqueia: Caso clínico e indicações para tratamento conservador

Iatrogenic tracheal rupture: A case report and indications for conservative management

 

 

Miguel S. Guerra¹

José António Miranda¹

António Caiado²

José Almeida²

João Moura e Sá²

Francisco Leal¹

Luís Vouga¹

 

 

Resumo

As rupturas iatrogénicas traqueobrônquicas após entubação orotraqueal obrigam, habtualmente, a uma intervenção imediata. Tem sido descrito um crescente número de casos em que se optou, com sucesso, pelo tratamento não cirúrgico. Os autores descrevem um caso de uma mulher de 47 anos que sofreu uma ruptura traqueal iatrogénica, durante a entubação orotraqueal para uma cirurgia ortopédica com anestesia geral. Optou-se por um tratamento conservador com antibiótico de largo espectro, dada a estabilidade clínica da doente e o diagnóstico tardio com mais de 72 horas de evolução. A broncofibroscopia foi o exame de diagnóstico de selecção do tipo de tratamento e de confirmação da cicatrização da ruptura. Os autores fazem ainda uma revisão da literatura disponível sobre as indicações para tratamento conservador das rupturas traqueobrônquicas. O tratamento adequado baseia-se nos achados clínicos, radiológicos e broncoscópicos. A morbi-mortalidade aumenta quando o diagnóstico e o tratamento não são imediatos.

Palavras-chave: Ruptura traqueia, tratamento conservador, entubação orotraqueal.

 

 

Abstract

Tracheal rupture after endotracheal intubation requires inmediate intervention. There have been an increasing number of reports that describe nonsurgical manangement of this issue. We report the case of a 47-year-old woman who experienced an iatrogenic tracheal rupture during endotracheal intubation for a surgical procedure with general anaesthesia. She was successfully managed conservatively with a broad-spectrum antibiotic. We managed it non-operatively, because the patient had a small tear, was hemodynamically stable, show no evidence of infection or respiratory failure, and the diagnosis was not immediate. Broncoscopy was a good diagnostic tool and it was used to make decisions regarding conservative management, and to detect granulation tissue and rule out any tracheal stenosis after treatment. We review available literature on conservative management of tracheal rupture. Immediate recognition and adequate treatment are very important in managing this potentially fatal situation. The final decision should be based on clinical, radiologic and broncoscopic findings.

Key-words: Tracheal rupture, conservative manangement, endotraqueal intubation.

 

 

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¹ Serviço de Cirurgia Cardiotorácica

² Sector de Broncologia do Serviço de Pneumologia

Centro Hospitalar de Vila Nova de Gaia, Portugal

Correspondência: Miguel S. Guerra. Serviço de Cirurgia Cardiotorácica. Centro Hospitalar de Vila Nova de Gaia

Rua Conceição Fernandes

4434-502 Vila Nova de Gaia, Portugal

Tel: (+351) 227865100

Tlm: (+351) 933734217

Fax: (+351) 227865170

Email: migueldavidguerra@yahoo.com

 

Recebido para publicação/received for publication: 05.10.06

Aceite para publicação/accepted for publication: 05.11.25