Tracheal rupture is an infrequent, severe complication of endotracheal intubation, which can be difficult to diagnose. Post-intubation tracheal rupture (PiTR) is distinct from non-iatrogenic causes of tracheobronchial trauma and often requires different treatment. The increasing adoption of pre-hospital emergency services increases the likelihood of such complications from emergency intubations. Effective management strategies for PiTR outside specialist cardiothoracic units are possible. Two cases of severe PiTR, successfully managed non-operatively on a general medical-surgical intensive care unit, illustrate a modified approach to current standards. The evidence base for PiTR is reviewed and a pragmatic management algorithm presented.
Massard G, Rougé C, Dabbagh A, Kessler R, Hentz JG, Roeslin N, et al. Tracheobronchial lacerations after intubation and tracheostomy. Ann Thorac Surg 1996;61:1483-7.
Conti M, Pougeoise M, Wurtz A, Porte H, Fourrier F, Ramon P, et al. Management of postintubation tracheobronchial ruptures. Chest 2006;130:412-8.
Macklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to the mediastinum. Arch Intern Med 1939;64:913-26.
Nishiumi N, Maitani F, Yamada S, Kaga K, Iwasaki M, Inokuchi S, et al. Chest radiography assessment of tracheobronchial disruption associated with blunt chest trauma. J Trauma 2002;53:372-7.
Faure A, Floccard B, Pilleul F, Faure F, Badinand B, Mennesson N, et al. Multiplanar reconstruction: A new method for the diagnosis of tracheobronchial rupture? Intensive Care Med 2007;33:2173-8.
Carbognani P, Bobbio A, Cattelani L, Internullo E, Caporale D, Rusca M. Management of postintubation membranous tracheal rupture. Ann Thorac Surg 2004;77:406-9.
Ross HM, Grant FJ, Wilson RS, Burt ME. Nonoperative management of tracheal laceration during endotracheal intubation. Ann Thorac Surg 1997;63:240-2.
Wurtz A, Benhamed L, Hysi I, Conti M. Endoscopic or conservative management of postintubation tracheal membrane laceration. Ann Thorac Surg 2011;91:1654-5.
Jougon J, Ballester M, Choukroun E, Dubrez J, Reboul G, Velly JF. Conservative treatment for postintubation tracheobronchial rupture. Ann Thorac Surg 2000;69:216-20.
Gómez-Caro Andrés A, Moradiellos Díez FJ, Ausín Herrero P, Díaz-Hellín Gude V, Larrú Cabrero E, de Miguel Porch E, et al. Successful conservative management in iatrogenic tracheobronchial injury. Ann Thorac Surg 2005;79:1872-8.
Yopp AC, Eckstein JG, Savel RH, Abrol S. Tracheal stenting of iatrogenic tracheal injury: A novel management approach. Ann Thorac Surg 2007;83:1897-9.
Du Rand IA, Barber PV, Goldring J, Lewis RA, Mandal S, Munavvar M, Singh S, et al. British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Thorax 2011;66 Suppl 3:iii1-21.