Iatrogenous tracheal lesions following intubation: Problem und management

Objective: Tracheobronchial lesions are rare emergencies and sequence of blunt or open chest trauma. Some lesions however, especially in the trachea, represent rare complications following endotracheal intubation, also in cardiac patients. Iatrogenous lesions demand diagnostic evaluation immediately. Prognosis may be well following treatment in time.

Material and methods: Since 2001 six patients (mean age 41,2 years; range 13–79 years) were treated with iatrogenous lesions of the trachea, following elective single-lumen-intubation in three and emergency intubation in another three pts. Typical symptoms were cutanous or mediastinal emphysema, dyspnea, chest pain and hemoptysis. Due to emergency tracheobronchoscopy lesions of the mid and distal trachea of 3 to 5cm length were diagnosed (mean 4,4cm). Tracheal surgery was performed in all cases via right-sided thoracotomy, tracheal reconstruction with interrupted sutures and suture line protection with local mediastinal tissue.

Results: Postoperative course was uneventful in 4 pts.. One pt. with long-range lesion, difficult reconstruction of tracheal defect and significant cardiac comorbidity needed ECMO therapy temporary. One pt. died on POD 6 of status epilepticus resistant to therapy and multiorgan failure, although regular healing of trachea lesion was shown. Mean time in ICU was 7,5 days (range 2–17 days). Finally, in 5 of 6 pts. healing of trachea lesion was confirmed endoscopically without any pulmonary functional loss.

Conclusion: Iatrogenous tracheal lesions following intubation are life-threatening complications. In all cases emergency tracheobronchoscopy is indicated for diagnosis and treatment, the latter is surgical mainly, and will be presented in context of current literature.