Surgery of the Trachea and Bronchi
There was no apparent active bleeding, only clots, which were aspirated. Conservative treatment was chosen due to the acute neurological condition of the patient.gelatocottage.sg/includes/map8.php
Tracheobronchial injury - Wikipedia
The orotracheal tube was inserted endoscopically with its cuff positioned distally to the lesion, and antibiotic therapy with coverage of tracheobronchial tree pathogens was introduced. The subcutaneous emphysema progressively decreased. The bronchoscopy performed on post-intubation day 8 showed that the lesion had healed completely without treatment. Due to the neurological damage caused by the underlying disease, cervical tracheostomy was then performed. Iatrogenic tracheal injury due to orotracheal intubation is a rare entity. Its incidence is approximately 0.
Topographically, it occurs predominantly in the distal third of the trachea and in the main bronchi, at the junction of the membranous and cartilaginous portions.
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The major mechanisms of injury are the use of an inappropriate tube size, cuff overinflation and sudden movements in the tube. Direct injury caused by the tube usually occurs after multiple, vigorous attempts at orotracheal intubation in emergency situations. The most common clinical manifestations are subcutaneous emphysema in the chest and neck, as well as pneumomediastinum, pneumothorax and respiratory failure. Radiological findings such as subcutaneous or mediastinal emphysema, extension of the tip of the endotracheal tube to the right and cuff overinflation, are usually indirect signs of injury.
There are two treatment options: surgery and conservative management. Surgical correction is indicated at the first sign of ventilatory instability or if there is evidence of mediastinitis.
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In patients on mechanical ventilation, conservative treatment consists in positioning the tracheal tube cuff distal to the lesion. In patients who do not depend on mechanical ventilation, clinical observation is indicated, with surgical intervention at the first sign of ventilatory instability or mediastinitis. All of the case series of post-intubation tracheal injury have involved small numbers of patients, of varying ages, and there has been a predominance of females. The reported mortality is low, being slightly higher in patients submitted to surgical treatment. In patients who had poor general health status and multiple comorbidities, deaths were not related to the tracheal injury or to the surgery itself but rather to clinical complications Table 1.
The data presented previously are corroborated by our case series, in which all patients were female, required emergency orotracheal intubation due to respiratory failure and were difficult to intubate. Treatment was immediate. Two patients were submitted to surgical treatment, and one was submitted to conservative treatment. In the first two cases reported here, the patients were treated surgically because they had an extensive lesion located in the distal trachea and the respiratory isolation of the lesion was difficult.
One patient who had suffered a cerebrovascular accident died due to respiratory sepsis, despite evidence of adequate tracheal healing. In the second case, due to impaired neurological function, the patient required a tracheostomy and a prolonged hospital stay. In the third case, the patient was treated conservatively because she had a smaller, more proximal lesion, which facilitated respiratory isolation.
Grillo HC. Tracheal and Bronchial Trauma. In: Grillo HC, editor. Surgery of the Trachea and Bronchi. Lewiston: BC Decker; Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg. It can also be used to assess the muscles of the chest wall and mechanics of breathing.
Tracheal and Airway Tumors
It is particularly useful for assessing the thyroid gland when it is abnormally large and impinging on the trachea. It is essential in the diagnosis of airway and lung diseases. Advanced 3-D reconstructions are particularly useful in planning treatment for airway conditions. A bronchoscopy allows the surgeon to make a special endoscopic evaluation of the larynx, trachea and bronchi.
This can be augmented with endobronchial ultrasound EBUS , which allows sonographic visualization of the tissue around the airway, most specifically the lymph nodes. EBUS is essential in diagnosing and staging tumors of the trachea, lungs and esophagus. Biopsy samples are evaluated under the microscope by pathologists on the medical staff, and rare cases are further reviewed at an interdisciplinary tumor board.
Treatment Options Diseases and conditions in the trachea are complex and require a multidisciplinary approach.
Diseases of the Trachea and Airway
Minimally Invasive Options Interventions using an endoscope can be performed as definitive treatment of many conditions or to lessen symptoms. This can be done mechanically or with the aid of argon beam or laser therapy. This can be performed as a temporary or permanent measure and allows for symptom relief while other treatments are administered, such as chemotherapy or radiation.
Surgery Open tracheal surgery is complex and requires a specialized surgical center and a highly trained team. More information about this seller Contact this seller 4.
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