Acute injuries of the trachea and major bronchi: Importance of early diagnosis

Background. Tracheobronchial injuries are encountered with increasing frequ ency because of improvements in prehospital care and early initiation of th e Advanced Trauma Life Support protocol. We review our experience with thes e injuries with the hypothesis that the leading determinant of patient outc ome is the time interval to diagnosis. Methods. Patients with tracheobronchial injury were identified from the reg istry of our level 1 trauma center during a 10-year period ending December 1997. Clinical presentation, diagnostic evaluation, surgical management, an d outcome were reviewed. Results. Twenty patients with ten cervical tracheal injuries and ten intrat horacic tracheobronchial injuries were treated. The mechanism of injury inv olved blunt trauma in 11 and penetrating trauma in 9. All patients underwen t surgical debridement and primary repair. Patients with isolated airway in juries were discharged home after a mean hospital stay of 6 days and had no early complications. Three patients had delayed diagnosis (> 24 hours), an d all sustained complications including: death (1 patient) and multiorgan s ystem failure (2 patients). The overall mortality rate was 15%. Conclusions. Operative management of tracheobronchial injuries can be achie ved with acceptable mortality. Independent of mechanism or anatomic locatio n of injury, delay in diagnosis is the single most important factor influen cing outcome. Early recognition of tracheobronchial injury and expedient in stitution of appropriate surgical intervention are essential in these poten tially lethal injuries. (C) 2000 by The Society of Thoracic Surgeons.