Conservative Therapy in Iatrogenic Tracheal Rupture: A Retrospective Analysis and a Call for ResearchNicola Tamburini1*, Davide Morri2, Carlo Barbetta3, Pio Maniscalco1, Carlo Alberto Volta2, Roberto Zoppellari4, Giorgio Cavallesco1 and Franco Ravenna5
- *Corresponding Author:
- Nicola Tamburini
General and Thoracic Surgery Department
Sant’Anna Hospital, Ferrara-44124, Italy
E-mail: [email protected]
Received date: September 18, 2016; Accepted date: November 09, 2016; Published date: November 11, 2016
Citation: Tamburini N, Morri D, Barbetta C, Maniscalco P, Volta CA, et al. (2016) Conservative Therapy in Iatrogenic Tracheal Rupture: A Retrospective Analysis and a Call for Research. J Pulm Respir Med 6:380. doi: 10.4172/2161-105X.1000380
Copyright: © 2016 Tamburini N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Introduction: Iatrogenic tracheal rupture is a rare potentially life-threatening lesion. The best treatment has still not been determined in the case of mechanically ventilated patients for whom surgery has a high mortality rate.
The aim of this study is to assess the role of conservative management in patients with iatrogenic posterior tracheal wall perforation and to verify its role in critically ill mechanically ventilated patients.
Methods: We reviewed the cases occurred at our hospital: a retrospective study was performed and 7 patients over a four-year period were identified. Conservative treatment consisted in endoscopic evaluation of tracheal tear healing and O2 therapy when dealing with spontaneous breathing patients with none or few symptoms without progression. When symptoms progressed and spontaneous ventilation wasn’t possible, patients underwent tracheal intubation or tracheostomy tube replacement and inflation of the cuff distal to the tear. This conduct has been chosen in membranous trachea injuries, independent of the injury size, diagnostic delay, or cause.
Results: Conservative therapy was attempted in 5 over 7 cases, it was successful in all 5 cases without complications. No clinically evident mediastinitis or postoperative tracheobronchial stenosis was observed on endoscopic follow up.
Conclusion: Our retrospective analysis showed that nonsurgical treatment could be a safe and suitable solution to achieve tracheal healing secondary to membranous injury. In cases where mechanical ventilation is needed, bridging the tear with the tracheal tube seems to give good results. Surgical treatment is advisable in cases of mediastinitis, progression of emphysema and difficulty in bridging the defect with an artificial airway. In the lack of randomized clinical trials comparing surgical and conservative treatments we reviewed our cases and created the ConservAtive vs surgery registry of tracheal ruPTUREs (CAPTURE registry) to collect data from different centers to provide clinicians with further evidences.