Acute Nonpenetrating Tracheobronchial Injuries: What Is Important in the Mortality?

Nonpenetrating tracheobronchial disruption are rare and potentially life threatening and associated with blunt thoracic trauma. Sometimes diagnosis is missed. 2340 traumatic patients were admitted to the trauma center of Tabriz University Hospital, Iran. Only twelve patients of them had ruptured tracheobronchial airways following blunt chest trauma. In this retrospective study of twelve patients, we aim to document and evaluate causes, presentation, and diagnosis and treatment modalities over fourteen years (1993- 2006). All the cases admitted to our referral hospital from six hours to 72 hours, underwent surgical interventions. There were two deaths; one in the operating room because of massive bleeding of pulmonary vascular disruptions coexisted with trachobronchial injuries and in other due to severity of disruption of carina, right and left bronchus five days after repair. Diagnosis was missed in one patient and he repaired after six month. Stricture formation of anastomotic site and localized empyema with bronchopleural fistula were the complications of two patients. A high-level of suspicion in blunt thoracic trauma and use of bronchoscopy confirm the diagnosis of tracheobronchial disruption. Early diagnosis of tracheobronchial disruption is important, but severity of disruptions predisposes mortality.