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.
Texto completo disponível apenas em PDF
Full text only available in PDF format.
Bibliografia
1. Goudy SL, Miller FB, Bumpous JM. Neck crepitance: evaluation and management of suspected upper aerodigestive tract injury. Laryngoscope 2002; 112:791-795. [ Links ]
2. Smith BAC, Hopkinson RB. Tracheal rupture during anaesthesia. Anaesthesia 1984; 39:894-898. [ Links ]
3. Borasio P, Ardissone R, Chiampo G. Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg 1997; 12:98-100. [ Links ]
4. Ross HM, Grant FJ, Wilson RS, Burt ME. Nonoperative management of tracheal laceration during endotracheal intubation. Ann Thorac Surg 1997; 63:240-242. [ Links ]
5. Liu H, Jahr JS, Sullivan E, Waters PF. Tracheobronchial Rupture After Double-Lumen Endotracheal Intubation. Journal of Cardiothoracic and Vascular Anesthesia 2004; 18(2):228-233. [ Links ]
6. Spaggiari L, Rusca M, Carbognani P, Solli P. Tracheobronchial laceration after double-lumen intubation for thoracic procedures. Ann Thorac Surg 1998; 65:1837-1838. [ Links ]
7. D'Odemont JP, Rodeinstein DOA. Iatrogenic tracheobronchial lacerations [Letter]. Ann Thorac Surg 1997; 63:1209-1210. [ Links ]
8. Massard G, Rouge C, Dabbag A, et al. Tracheobronchial laceration after intubation and tracheostomy. Ann Thorac Surg 1996; 61:1483-1487. [ Links ]
9. Dohertya KM, Tabaeea A, Castillob M, Cherukupallya SR. Neonatal tracheal rupture complicating endotracheal intubation: a case report and indications for conservative management. International Journal of Pediatric Otorhinolaryngology 2005; 69:111-116. [ Links ]
10. Marty-Ane CH, Picard E, Jonquet O, Mary H. Membranous tracheal rupture after endotracheal intubation. Ann Thorac Surg 1995; 60(5): 1367-1371. [ Links ]
11. Wagner A, Roeggla M, Hirschl M, et al. Tracheal rupture after emergency intubation during cardiopulmonary resuscitation. Resuscitation 1995; 30:263-66. [ Links ]
12. Hofmanna HS, Rettigb G, Radkeb J, Neefa H, Silbera RE. Iatrogenic ruptures of the tracheobronchial tree European Journal of Cardio-thoracic Surgery 2002; 21:649-652. [ Links ]
13. Kaloud H, Smolle-Juettner FM, Prause G, List WF. Iatrogenic ruptures of the tracheobronchial tree. Chest 1997; 112(3):774-778. [ Links ]
14. Gabor S, Renner H, Pinter H, et al. Indications for surgery in tracheobronchial ruptures. Eur J Cardiothorac Surg 2001; 20:399-404. [ Links ]
15. Kaloud H, Smolle-Juettner F-M, Prause G, List WF. Iatrogenic Ruptures of the Tracheobronchial Tree. Chest 1997; 112:774-778. [ Links ]
16. Arunabh, Mayerhoff R, London D, Brooks M, Warshawsky R. Conservative management of tracheal rupture after endotracheal intubation. J Bronchol 2004; 11:22-26. [ Links ]
17. Jougon J, Ballester M, Choukroun E, Dubrez J, Reboul G, Velly J-F. Conservative Treatment for Postintubation Tracheobronchial Rupture. Ann Thorac Surg 2000; 69:216-20. [ Links ]
18. Marquette CH, Bocquillon N, Roumilhac D, et al. Conservative treatment of tracheal rupture. J Thorac Cardiovasc Surg 1999; 117:399-401. [ Links ]
19. Evagelopoulos N, Tosslos P, Wanke W, et al. Tracheobronchial rupture after emergency intubation. Thorac Cardiovasc Surg 1999; 47:395-397. [ Links ]
20. Carbognani P, Bobbio A, Cattelani L, Internullo E, Caporale D, Rusca M. Manangement of postintubation membranous tracheal rupture. Ann Thorac Surg 2004; 77:406-409. [ Links ]
21. D'Odemont JP, Pringot J, Goncette L, Goenen M, Rodenstein D. Spontaneous favorable outcome of tracheal laceration. Chest 1991; 99:1290-1292. [ Links ]
]]>
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
]]>