Abstract
Introduction Severe tracheobronchial injuries (TBI) in children are usually traumatic or iatrogenic.
However, they can also be caused by mediastinal infections that lead to critical situations.
We herein report our experience in the treatment of these lesions.
Methods A retrospective study was conducted for patients treated at our center from 2008
to 2014. TBI was diagnosed by imaging studies and bronchoscopy. Treatment was initially
conservative (drainage of air and secretions, mechanical ventilation with minimal
pressures, and an early extubation) with a limited use of surgical procedures whenever
necessary.
Results A total of 10 patients (7 males and 3 females) with a median age of 7.5 years (range,
3–17 years) suffered TBI. The mechanism was traumatic in six (three accidental and
three iatrogenic) and mediastinal infection in four (three mycotic and one bacterial
abscesses). All traumatic cases responded to conservative measures, except one iatrogenic
lesion, which was surgically repaired. There were no complications or residual damages.
Two patients with mediastinal infection presented with sudden cardiorespiratory arrest,
one with hemoptysis caused by an arteriotracheal fistula and the other because of
carinal rupture. Both died before any therapeutic measures could be taken. The other
two patients were treated, one with previous extracorporeal membrane oxygenation support,
underwent arterial embolization, but ultimately died, and the other one survived,
but required esophagectomy and creation of a thoracostome for secondary wound closure
of the bronchocutaneous fistula.
Conclusion Conservative treatment with gentle respiratory support suffices in most traumatic
cases of TBI. Infectious abscesses with involvement of adjacent structures sometimes
require complex surgery and are life-threatening.
Keywords
tracheobronchial - airway injury - thoracic trauma - cervical trauma - children
