Archivos de Bronconeumología (English Edition) Archivos de Bronconeumología (English Edition)
Arch Bronconeumol 2017;53:75-6 - Vol. 53 Num.2 DOI: 10.1016/j.arbr.2016.06.025
Clinical Image
Iatrogenic Tracheal Rupture After Emergent Intubation
Rotura traqueal yatrogénica tras una intubación de urgencia
Chuan-Liang Choua, Ting-I Leea,b, Ting-Yu Huc,,
a Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipéi, Taiwan
b Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipéi, Taiwan
c Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipéi, Taiwan

A frail 80-year-old woman presented with dyspnea due to an asthma attack and acute respiratory failure requiring emergency orotracheal intubation. Subsequent cervicofacial subcutaneous emphysema developed, extending to the anterior chest wall. Chest X-ray revealed pneumothorax with extensive subcutaneous emphysema of the chest (Fig. 1A).

Fig. 1.
(0.18MB).

(A) Pneumothorax and subcutaneous emphysema of the chest. (B) Lower tracheal defect (black arrow). (C) Rupture (white arrow) of lower posterior wall of the trachea.

The emphysema slowly improved in the intensive care unit, and the follow-up chest computed tomography conducted a week later revealed a lower tracheal defect (Fig. 1B, black arrow). Bronchoscopy confirmed rupture of the lower posterior wall of the trachea, showing a 2cm vertical lesion (Fig. 1C, white arrow) located 1cm above the carina. Subsequently, a T-piece was used for spontaneous breathing, and subcutaneous emphysema gradually resolved. The patient was transferred to another hospital for further care.

Iatrogenic tracheal injury due to tracheal intubation is rare, with an incidence of 1/20000.1 A multitude of risk factors for the injury have been reported, including advanced age, female sex, and tracheal inflammatory lesions. All of above were detected in our case. Clinical manifestations include dyspnea, hemoptysis, mediastinal emphysema, subcutaneous emphysema, and pneumothorax.1 An emergent bronchoscopy is necessary to determine the degree of injury.2

Tracheal injury during intubation is unusual, serious, and difficult to recognize. Early diagnosis is crucial to prevent further complication and mortality.2

References
1
E. Miñambres,J. Burón,M.A. Ballesteros,J. Llorca,P. Muñoz,A. González-Castro
Tracheal rupture after endotracheal intubation: a literature systematic review
Eur J Cardiothorac Surg, 35 (2009), pp. 1056-1062 http://dx.doi.org/10.1016/j.ejcts.2009.01.053
2
C. Prokakis,E.N. Koletsis,P. Dedeilias,F. Fligou,K. Filos,D. Dougenis
Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment
J Cardiothorac Surg, 9 (2014), pp. 117 http://dx.doi.org/10.1186/1749-8090-9-117

Please cite this article as: Chou C-L, Lee T-I, Hu T-Y. Rotura traqueal yatrogénica tras una intubación de urgencia. Arch Bronconeumol. 2017;53:75–76.

Corresponding author. (Ting-Yu Hu 95284@w.tmu.edu.tw)
Copyright © 2016. SEPAR
Arch Bronconeumol 2017;53:75-6 - Vol. 53 Num.2 DOI: 10.1016/j.arbr.2016.06.025