Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
Postgraduate Medical School in Hygiene and Preventive Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
Clin Ter. 2024 Jul-Aug;175(4):203-207. doi: 10.7417/CT.2024.5063.
Tracheal injury may be a rare complication of the endotracheal intubation procedure. Incidence and determinant factors are not well known, nevertheless a greater incidence have been recognized with a difficult maneuver or the use of nitrogen peroxide. The therapeutic approach can be conservative or surgical, depending on the characteristics of the lesion and of the patient and therefore the outcomes of medico-legal interest can be different.
It is a case of alleged medical liability regarding a 70-year-old woman, that during the intubation procedure was pouncing on the right. Furthermore, nitrous oxide was used as an anaesthetic. A few hours after the operation the patient showed swelling on the right half of the face and on the right lateral region of the neck. The emergency chest CT scan highlighted subcutaneous emphysema and pneumomediastinum. In the operating room, fibrobronchoscopy was performed with a double-lumen bronchial tube which confirmed the hypotheses lesion; then, right posterolateral thoracotomy was perfor-med followed by suturing of the tracheal lesion. Subsequently, the patient was discharged in good clinical conditions but with a scar in the region of the right hemithorax.
Iatrogenic tracheal injury is a rare and fearful complication of the orotracheal intubation procedure. Although risk factors that increase the probability of its onset have been recognized, in most cases it is not possible to identify the cause. From a medico-legal point of view, tracheal injury after intubation is unpredictable and inevitable, so in the case reported it was decided to proceed with a conciliatory solution.
气管损伤可能是气管插管过程中的罕见并发症。其发生率和决定因素尚不清楚，但在操作困难或使用一氧化二氮时，发生率会更高。治疗方法可以是保守的，也可以是手术的，这取决于病变和患者的特点，因此医学法律方面的结果可能不同。
这是一起关于一名 70 岁女性的医疗责任纠纷，在插管过程中，她的身体向右侧扭转。此外，还使用了一氧化二氮作为麻醉剂。术后数小时，患者出现右侧面部和右侧颈部外侧肿胀。紧急胸部 CT 扫描显示皮下气肿和气胸。在手术室，使用双腔支气管导管进行纤维支气管镜检查，证实了病变的假设；然后进行右侧后外侧开胸术，并缝合气管损伤。随后，患者在良好的临床条件下出院，但右侧胸腔区域有一处疤痕。
医源性气管损伤是经口气管插管过程中罕见且可怕的并发症。尽管已经认识到增加其发生概率的危险因素，但在大多数情况下，无法确定其原因。从医学法律的角度来看，插管后气管损伤是不可预测和不可避免的，因此在报告的病例中，决定通过和解解决。
