Management of tracheobronchial injuries following blunt and penetrating trauma.

Disruptions of the trachea and bronchi are an infrequent but a life-threatening injury following trauma. We reviewed our experience with tracheobronchial injury from 1988 to 1996. Out of 12,789 trauma patients treated at a university Level I trauma center, 16 patients (0.13%) with tracheobronchial injuries were seen. Mechanism of injuries involved gunshot wound in eight (50%), stab wound in two (13%), blunt trauma in three (19%), hanging injury from suicide attempt in one (6%), and intubation injury in two (13%). Preoperative diagnostic bronchoscopy was performed in 11 patients. Emergent operative exploration was needed in most penetrating tracheal injuries. All patients with blunt trauma had multisystem involvement with numerous associated injuries. Management of these injuries included early primary repair of the disrupted airway in 12 (75%), stenting of the injured airway in two (13%), and negative pressure mechanical ventilation with the iron lung in one (6%). Nonoperative management was successful in three (19%). Early mortality was 13 per cent. A high index of suspicion is essential for rapid diagnosis and successful surgical intervention in patients with tracheobronchial injuries.