Tracheobronchial ruptures (TBR) are life-threatening
|
|
- Brook Bishop
- 5 years ago
- Views:
Transcription
1 Conservative Treatment for Postintubation Tracheobronchial Rupture Jacques Jougon, MD, Michel Ballester, MD, Emmanuel Choukroun, MD, Jean Dubrez, MD, Gilles Reboul, MD, and Jean-François Velly, MD Thoracic Surgery Unit, Centre Médico-Chirurgical, Haut Lévèque Hospital, Pessac, France Background. Postintubation tracheobronchial rupture is usually responsible for unstable intraoperative or postoperative conditions, and its management is discussed. We insist on conservative treatment as a viable alternative after late diagnosis of postintubation tracheobronchial rupture. Methods. We conducted a retrospective study including 14 consecutive patients treated between April 1981 and July Results. Twelve tracheobronchial ruptures occurred after intubation for general surgery and two after thoracic surgery. In all cases, the tear consisted of a linear laceration of the posterior membranous wall of the tracheobronchial tree ranging from 2 to 6 cm. One death occurred in a very weak patient unfit to undergo a redo operation for surgical repair. Seven patients were treated conservatively and cured without sequelae. Six patients underwent surgical repair, of whom 2 were diagnosed and repaired intraoperatively. Conclusions. Aggressive surgical repair is not always mandatory after delayed diagnosis of iatrogenic tracheobronchial rupture. Conservative treatment must often be considered, except after lung resection. (Ann Thorac Surg 2000;69:216 20) 2000 by The Society of Thoracic Surgeons Tracheobronchial ruptures (TBR) are life-threatening lesions that most commonly occur after blunt trauma to the chest [1] but also may be a complication, hopefully very rare, of l intubation [2]. It is in these situations, where physicians sometimes feel guilty, that the decision of nonsurgical treatment is harder to take. Therefore, the choice between conservative treatment or surgical treatment sometimes implies long debates between physicians [3 5]. The purpose of this study is to examine a series of 14 patients treated in our department for TBR consecutive to l intubation; 6 of these patients having undergone l or bronchial surgical repair and 7 (50%) medical treatment. Retrospective analysis of different cases and review of the literature allows us to propose a decisiontaking algorithm of the best treatment of TBR after l intubation. Patients and Methods All patients treated in our department between April 1981 and July 1998 for TBR consecutive to intubation were reviewed. All data concerning patient history, conditions of intubation, presenting symptoms, endoscopic and radiologic findings, treatment and outcome were carefully reviewed. There were 14 patients (12 women and 2 men) ranging Accepted for publication June 6, Address reprint requests to Dr Jougon, Thoracic Surgery Unit, Centre Médico-Chirurgical, Haut Lévèque Hospital, Pessac Cédex, France; jacques.jougon@chu-aquitaine.fr. in age from 6 to 72 years (mean, 59 years). In 3 cases, the l rupture was consecutive to l intubation performed in our department. All other patients came from other hospitals and were referred to our center for diagnosis or treatment. Etiology The intubation tube used was a single-lumen tube in 11 cases and a double-lumen endol tube in 3 cases. Causes for intubation are reported in Table 1. Analysis of the conditions of intubation revealed difficulties due to severe facial injury by shotgun in 1 case. In all other cases, there was not any particular difficulty found. Diagnosis In 2 patients, the injury was diagnosed and treated intraoperatively. In one case, the l tear was recognized after exploration of an air infiltration surrounding l tissues during thyroidectomy. In the second case, the tear occurred with a double lumen intubation during an esophageal resection. After removal of the esophagus, the inflated left bronchial cuff appeared in the operative field. In 4 patients, signs of l rupture appeared immediately causing respiratory distress with important desaturation during anesthesia. Bilateral occurred in 2 cases, left tension in 1 case, and tension pneumomediastinum in 1 case. In 1 of these cases, the patient had remained intubated with a very large overinflated l cuff in order to allow the medical transport to our unit (Figs 1 and 2) by The Society of Thoracic Surgeons /00/$20.00 Published by Elsevier Science Inc PII S (99)
2 Ann Thorac Surg JOUGON ET AL 2000;69: IATROGENIC TRACHEOBRONCHIAL RUPTURE 217 Table 1. Patient Characteristics Case Sex Age Reason for Intubation Presenting Symptoms Endoscopic Findings (length of the tear/ location) Free Interval Before Diagnosis (h) Treatment Outcome 1 F 6 Appendectomy 2 cm, cervicothoracic 2 F 59 Cholecystectomy Respiratory distress, 4 cm, thoracic bilateral 3 F 70 Coma Respiratory distress 3 cm, thoracic 4 F 80 Hip joint replacement 5 F 40 Face trauma Respiratory distress, (shotgun) bilateral 6 F 72 Internal saphenous, vein stripping hemoptysis 7 F 64 Cholecystectomy 8 F 62 Shoulder wrench 9 F 71 Total hip joint replacement 10 M 61 Esophagectomy Per operative discovery 11 F 69 Hysterectomy 12 F 70 Ankle fracture Respiratory distress, left 13 F 35 Thyroidectomy Per operative discovery 14 M 61 Right lung Excessive air leak lobectomy 3 cm, thoracic 2 cm, thoracic 4 cm, thoracic and recovery 24 Surgical Per primam 3 cm, carena 24 Medical Per primam 3.5 cm, 144 Medical Per primam cervicothoracic 2 cm, on carena 0 Medical Per primam 3 cm, left bronchus stem 2.5 cm, thoracic 24 Medical Per primam 6 cm, thoracic 2 cm, cervical 3 cm, left bronchus stem 24 None Death In 1 patient, excessive air leak and respiratory distress on the 2nd postoperative day after right pulmonary lobectomy led to the diagnosis of a left stem bronchus rupture. In 7 patients, presenting symptoms were more insidious and occurred later on. Clinically, we noted head and neck subcutaneous, nasal voice, and pneumomediastinum on chest radiograph (see Table 1). Hemoptysis occurred in 1 case only. Endoscopy Definite diagnosis was performed bronchoscopically in all cases except those diagnosed intraoperatively (see above). Endoscopic findings are reported in Table 1. The tear was always unifocal and was found at the membranous part or at the junction of the membranous wall and the cartilage. It involved the in 9 patients, the carina in 3, and the left main bronchus in 2. In all cases, tears were linear and parallel to the bronchial tree. Treatment Six patients underwent surgery. The tear was always sutured by total layer of interrupted resorbable knots secondarily covered by a muscular or pleural flap. The patient who suffered from a left stem bronchus rupture after right pulmonary lobectomy was unfit to undergo surgery at time of diagnosis. He was a very weak patient who died a few hours after the endoscopic diagnosis from respiratory distress and cardiac failure. Seven patients underwent medical treatment. All tears occurred after single lumen tube intubations. Presenting symptoms were most often poor and sometimes delayed. Nevertheless, 1 patient presented an acute bilateral which was rapidly exsulfated by bilateral pleural suction. Tracheobronchial lacerations measured 1 to 3.5 cm long. Medical treatment included a broad spectrum antibiotherapy against the tracheobronchial flore, antiseptic antiinflammatory aerosoltherapy, and chest tube in 1 patient. When the subcutaneous was relapsed or important to cause shutting of the
3 218 JOUGON ET AL Ann Thorac Surg IATROGENIC TRACHEOBRONCHIAL RUPTURE 2000;69: eyelids, we performed two short susclavian incisions and subcutaneous massages in order to evacuate the. Early stabilization of clinical symptoms without progression over a short period of time was the sine qua non condition for conservative treatment. Results The postoperative care of patients who underwent surgery was uneventful. All patients treated by medical means had favorable outcome. A fiberoptic bronchoscopy was systematically performed at day 15 before discharge, and later on the 1st and 3rd months. Follow-up (median 30 months; ranging 3 months to 207 months) sometimes showed at first control small granulomas easily cauterized by laser but never revealed any scar sequellae or stenosis. Comment Fig 1. Chest x-ray film of patient 12 showing overinflation of the cuff of the endol tube, pneumomediastinum, and subcutaneous. Fig 2. Computed tomographic scan of patient 12 showing the endol tube with an overinflated cuff between the sternum and the vertebrae. The incidence of TBR after intubation is rare considering the number of l intubations performed for general anesthesia. However some short tears, spontaneously favorable, are probably misdiagnosed [6, 7]. After double-lumen tube intubations, the frequency of TBR remains low, estimated under 1% (0.12% for Borasio and colleagues [6]; 0.05% for Personne and coworkers [7]; 0.37% for Spaggiari and associates [3]). The most recent series report approximately 10 cases [5, 6, 8, 9] (Table 2). Mechanisms for tracheobronchial ruptures have been largely described [5, 8]. In most cases, they are due to an overinflated cuff, or to sudden moves of the tube. A direct tear caused by the tube itself remains rare. These mechanisms explain the location of the lesions, which are posterior, mainly concerning the membranous wall of the or the junction between the membranous wall and the cartilage. After double lumen intubation, TBR is explained by the same mechanisms: overinflation of the bronchial or the l cuff, respectively, causing bronchial or l rupture. Inadequate intubation tube size is one of the most important risks factors reported in the literature [5]. This explains TBR predominance most particularly in short female patients. We also found this element in our study. Clinical symptoms occur either immediately during mechanical ventilation (compressive, extensive subcutaneous ) or are more insidious, arising in the postoperative period or later. The development of a postoperative subcutaneous must immediately lead to perform a fiberoptic bronchoscopy under sufficient local anesthesia to prevent extension of the by coughing if the patient has already been extubated. Chest radiograph can show a rightside deviation of the intubation tube [10] or an overinflated cuff, as it was once noted in one of our patients (Fig 1). Patients presenting with acute respiratory distress must undergo surgical treatment in the same operative time if it is possible. Outcome is always favorable. Prognosis depends mostly on the patient s general status. TBR occurring after pulmonary or mediastinal surgery, usually requiring double-lumen tubes, implies surgical treatment, even if the symptoms presented by the patient are delayed [3]. Indeed, intrapleural suction converts a tracheobronchial tear in a large bronchopleural fistula. Moreover intrapleural suction for lung reexpansion in a patient who underwent partial pulmonary resection may be inefficient. Nevertheless, 2 patients who underwent left pneumonectomy had favorable outcome after medical treatment of their l rupture [6, 7]. In these 2 cases reported, no surgical treatment was performed considering the important risks implied by a right thoracotomy under single right-lung mechanical ventilation. This is the only circumstance after pulmonary resection where medical treatment can be considered [3]. Surgical approach, as well as techniques of suture, have been already described elsewhere [5, 6, 8]. If pulmonary or mediastinal surgery has not been performed, conservative treatment in a thoracic surgery department under continuous care can be considered
4 Ann Thorac Surg JOUGON ET AL 2000;69: IATROGENIC TRACHEOBRONCHIAL RUPTURE 219 Table 2. Review of the Main Recent Series Location of Tear Conservative Treatment Death Surgical Treatment Free Interval Before Diagnosis Length of Tear (cm) Main Bronchus Middle and Lower Third Upper Third of Trachea Double Tube Tracheostomy Single Tube No. of Patients References h Massard et al [5] days 6 1 tracheostomy Borasio et al [6] h Marty-Ane et al [8] days Kaloud et al [9] Present series days [11, 12]. In our series, in the patients who were treated conservatively, presenting symptoms were immediate in 1 patient only, and delays of 1, 2, and 6 days in, respectively, 2, 3, and 1 patients. The tear must be shorter than one third of the (4 cm), which is the mean length of the endol cuff. These tears caused by the overinflated cuff are not deep in the mediastinum or associated with esophageal lesion. A tear more than 4 cm is generally deeper and produced by withdrawing of the tube without deflation of the cuff. Clinical signs must been stable without progression over a short period of time. Temporary tracheostomy has been proposed in such circumstances [6], as well as l intubation [9], their aim being to prevent the patient from sudden intrabronchial hyperpressures caused by coughing, which may worsen subcutaneous and widen the tear. In our series, we always tried to avoid tracheostomy, performing short subclavian skin incisions associated to cutaneous massages in order to evacuate. We consider that surgical treatment is the appropriate treatment when a tracheostomy is indicated. A broad-spectrum antibiotherapy against common tracheobronchial flore associated to antiinflammatory aerosoltherapy were prescribed. A bronchoscopy was performed at day 15 after the l rupture and always showed perfect scarring. We never found stenosis, thus confirming findings of international literature reports. According to our experience and after having reviewed the literature, we propose an algorithm for the treatment of postintubation TBR on Figure 3. Fig 3. Algorithm for assessment of postintubation tracheobronchial ruptures.
5 220 JOUGON ET AL Ann Thorac Surg IATROGENIC TRACHEOBRONCHIAL RUPTURE 2000;69: We conclude that surgical repair must be performed for postintubation l ruptures occurring after thoracic surgery. Nevertheless, conservative treatment has to be discussed when the tear involved in TBR is short, revealed by poor symptoms, and occurs after general anesthesia for nonthoracic surgical procedures. Care must be taken to choose a small-size tube during intubation of short female patients. References 1. Velly JF, Martigne C, Moreau JM, Dubrez J, Kerdi S, Couraud L. Post traumatic tracheobronchial lesions. Eur J Cardiothorac Surg 1991;5: Kumar SM, Pandit SK, Cohen PJ. Tracheal laceration associated with endol anesthesia. Anesthesiology 1977;47: Spaggiari L, Rusca M, Carbognani P, Solli P. Tracheobronchial laceration after double-lumen intubation for thoracic procedures. Ann Thorac Surg 1998;65: D Odemont JP, Rodeinstein DOA. Iatrogenic tracheobronchial lacerations [Letter]. Ann Thorac Surg 1997;63: Massard G, Rougé C, Dabbag A, et al. Tracheobronchial laceration after intubation and tracheostomy. Ann Thorac Surg 1996;61: Borasio P, Ardissone F, Chiampo G. Post-intubation l rupture. A report on ten cases. Eur J Cardiothorac Surg 1997;12: Personne C, Kleinmann P, Bisson A, Toty L. Les déchirures trachéo-bronchiques par tube de Carlens. Ann Chir 1987;41: Marty-Ane CH, Picard E, Jonquet O, Mary H. Membranous l rupture after endol intubation. Ann Thorac Surg 1995;60: Kaloud H, Smolle-Juettner FM, Prause G, List WF. Iatrogenic ruptures of the tracheobronchial tree. Chest 1997;112: Rollins RJ, Tocino I. Early radiographic signs of l rupture. Am J Radiol 1987;148: Ross HM, Grant F, Wilson RS, Burt M. Non operative management of l laceration during endol intubation. Ann Thorac Surg 1997;63: D Odemont JP, Pringot J, Goncette L, Goenen M, Rodenstein D. Spontaneous favorable outcome of l laceration. Chest 1991;99:
pulmonary and critical care pearls
pulmonary and critical care pearls A 63-Year-Old Woman With Subcutaneous Emphysema Following Endotracheal Intubation* Bassam Hashem, MD; James K. Smith, MD, FCCP; and W. Bruce Davis, MD, FCCP (CHEST 2005;
More informationTracheal Trauma: Management and Treatment. Kosmas Iliadis, MD, PhD, FECTS
Tracheal Trauma: Management and Treatment Kosmas Iliadis, MD, PhD, FECTS Thoracic Surgeon Director of Thoracic Surgery Department Hygeia Hospital, Athens INTRODUCTION Heterogeneous group of injuries mechanism
More informationDespite the great number of intubations and diagnostic
Management of Iatrogenic Tracheobronchial Injuries: A Retrospective Analysis of 29 Cases Thomas Schneider, MD, Konstantina Storz, MD, Hendrik Dienemann, MD, PhD, and Hans Hoffmann, MD, PhD Department of
More informationIatrogenic Ruptures of the Tracheobronchial Tree*
Iatrogenic Ruptures of the Tracheobronchial Tree* Herbert Kaloud, MD; Freya-Maria Smolle-Juettner, MD; Gerhard Prause, MD; and Werner Franz List, MD We did a retrospective study in 12 patients with iatrogenic
More informationSuccessful Conservative Management in Iatrogenic Tracheobronchial Injury
Successful Conservative Management in Iatrogenic Tracheobronchial Injury Abel Gómez-Caro Andrés, MD, Francisco Javier Moradiellos Díez, MD, Pilar Ausín Herrero, MD, Vicente Díaz-Hellín Gude, MD, Emilio
More informationDiscussing feline tracheal disease
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Discussing feline tracheal disease Author : ANDREW SPARKES Categories : Vets Date : March 24, 2008 ANDREW SPARKES aims to
More informationPediatric Isolated Trachea Rupture Treated with a Conservative Approach İ Akdulum 1, M Öztürk 2, N Dağ 1, A Sığırcı 1 ABSTRACT
Pediatric Isolated Trachea Rupture Treated with a Conservative Approach İ Akdulum 1, M Öztürk 2, N Dağ 1, A Sığırcı 1 ABSTRACT Tracheobronchial rupture as a result of blunt thoracic trauma is extremely
More informationManagement of Airway Trauma I:
Management of Airway Trauma I: Tracheobronchial Injuries James P. Kelly, M.D., Watts R. Webb, M.D., Peter V. Moulder, M.D., Charles Everson, M.D., Buford H. Burch, M.D., and Edward S. Lindsey, M.D. ABSTRACT
More informationConservative management of post-intubation tracheal tears report of three cases
Case Report Conservative management of post-intubation tracheal tears report of three cases Attila Óvári 1, Tino Just 1, Steffen Dommerich 2, Volker Hingst 3, Arne Böttcher 4, Tobias Schuldt 1, Ellen Guder
More informationISPUB.COM. Rare Cases: Tracheal/bronchial Obstruction. O Wenker, L Moehn, C Portera, G Walsh HISTORY ADMISSION
ISPUB.COM The Internet Journal of Radiology Volume 1 Number 1 O Wenker, L Moehn, C Portera, G Walsh Citation O Wenker, L Moehn, C Portera, G Walsh.. The Internet Journal of Radiology. 1999 Volume 1 Number
More informationEsophageal Perforation
Esophageal Perforation Dr. Carmine Simone Thoracic Surgeon, Division of General Surgery Head, Division of Critical Care May 15, 2006 Overview Case presentation Radiology Pre-operative management Operative
More informationCurrent Management of Postpneumonectomy Bronchopleural Fistula
Current Management of Postpneumonectomy Bronchopleural Fistula Shaf Keshavjee MD MSc FRCSC FACS Surgeon-in-Chief, University Health Network James Wallace McCutcheon Chair in Surgery Professor, Division
More informationTracheal stenosis in infants and children is typically characterized
Slide Tracheoplasty for Congenital Tracheal Stenosis Peter B. Manning, MD Tracheal stenosis in infants and children is typically characterized by the presence of complete cartilaginous tracheal rings and
More informationA Tracheostomy Complication Resulting from Acquired Tracheomalacia: A Case report
A Tracheostomy Complication Resulting from Acquired Tracheomalacia: A Case report Bach T. Le, MD, DDS, James M. Eyre, Jr., MD, DMD, Eric P. Holmgren, MS, Eric J. Dierks, MD, DMD, FACS Key Words: tracheomalacia,
More informationImaging of Thoracic Trauma: Tips and Traps. Arun C. Nachiappan, MD Associate Professor of Clinical Radiology University of Pennsylvania
Imaging of Thoracic Trauma: Tips and Traps Arun C. Nachiappan, MD Associate Professor of Clinical Radiology University of Pennsylvania None Disclosures Objectives Describe blunt and penetrating traumatic
More informationCHAPTER 7 Procedures on Respiratory System
CHAPTER 7 Propunere noua clasificare proceduri folosind codificarea ICD-10-AM versiunea 3, 30 martie 2004 Procedures on Respiratory System BLOCK 520 Examination procedures on larynx 41764-03 Fibreoptic
More informationChildren are not small adults Children are Not Small Adults Anatomic considerations Pliable bony & cartilagenous structures - Significant thoracic inj
PEDIATRIC CHEST TRAUMA Children are not small adults Role of imaging Spectrum of injury Children are not small adults Children are Not Small Adults Anatomic considerations Pliable bony & cartilagenous
More informationTracheo-innominate artery fistula (TIF) is an uncommon
Technique for Managing Tracheo-Innominate Artery Fistula Gorav Ailawadi, MD Tracheo-innominate artery fistula (TIF) is an uncommon complication (0.1-1%) following both open and percutaneous tracheostomy.
More informationPneumothorax. Defined as air in the pleural space which can occur through a number of mechanisms
Pneumothorax Defined as air in the pleural space which can occur through a number of mechanisms Traumatic pneumothorax Penetrating chest trauma Common secondary to bullet or knife penetration Chest tube
More informationReconstructive surgery for combined tracheo-esophageal injuries and their sequelae q
European Journal of Cardio-thoracic Surgery 20 (2001) 1025 1029 www.elsevier.com/locate/ejcts Reconstructive surgery for combined tracheo-esophageal injuries and their sequelae q V.V. Sokolov, M.M. Bagirov*
More informationTRACHEOSTOMY. Tracheostomy means creation an artificial opening in the trachea with tracheostomy tube insertion
TRACHEOSTOMY Definition Tracheostomy means creation an artificial opening in the trachea with tracheostomy tube insertion Indications for tracheostomy 1-upper airway obstruction with stridor, air hunger,
More informationCase Presentation Surgery Grand Round. Amid Keshavarzi, MD UCHSC 4/9/2006
Case Presentation Surgery Grand Round Amid Keshavarzi, MD UCHSC 4/9/2006 Case Presentation 12 y/o female Presented to OSH after accidental swallowing of plastic fork in the bus, CXR/AXR form OSH did not
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Case Report Varied Presentation and Management of Tracheal Polyps in Children Vinod M Raj 1, Varun Hathiramani 2, Swathi
More informationCase Report. Management of recurrent distal tracheal stenosis using an endoprosthesis: a case report* Abstract. Introduction.
121 Case Report Management of recurrent distal tracheal stenosis using an endoprosthesis: a case report* André Germano Leite 1, Douglas Kussler 2 Abstract The authors report the case of a patient with
More informationRespiratory distress in patients with central airway obstruction
Indian J Thorac Cardiovasc Surg (2010) 26:151 156 DOI 10.1007/s12055-010-0021-0 ORIGINAL ARTICLE Respiratory distress in patients with central airway obstruction Mohamed Abdel Hamied Regal & Yasser Ahmed
More informationRepair of massive stent-induced tracheoesophageal fistula
Repair of massive stent-induced tracheoesophageal fistula Yong Han, MD, Kun Liu, MD, Xiaofei Li, MD, Xiaoping Wang, MD, Yongan Zhou, MD, Zhongping Gu, MD, Qunfeng Ma, MD, Tao Jiang, MD, Lijun Huang, MD,
More informationMassive hemoptysis: what place for medical and surgical treatment
European Journal of Cardio-thoracic Surgery 22 (2002) 345 351 www.elsevier.com/locate/ejcts Massive hemoptysis: what place for medical and surgical treatment Jacques Jougon a, *, Michel Ballester b, Frédéric
More informationSurgical indications: Non-malignant pulmonary diseases. Punnarerk Thongcharoen
Surgical indications: Non-malignant pulmonary diseases Punnarerk Thongcharoen Non-malignant Malignant as a pathological term: Cancer Non-malignant = not cancer Malignant as an adjective: Disposed to cause
More informationThe Surgical Treatment of Tracheobronchial Tuberculosis. The Thoracic Department of Beijing Chest Hospital, Capital Medical University
The Surgical Treatment of Tracheobronchial Tuberculosis ) The Thoracic Department of Beijing Chest Hospital, Capital Medical University Named also: endobronchial tuberculosis,ebtb defined as tuberculous
More informationLecture 2: Clinical anatomy of thoracic cage and cavity II
Lecture 2: Clinical anatomy of thoracic cage and cavity II Dr. Rehan Asad At the end of this session, the student should be able to: Identify and discuss clinical anatomy of mediastinum such as its deflection,
More informationThe use of metallic expandable tracheal stents in the management of inoperable malignant tracheal obstruction
The use of metallic expandable tracheal stents in the management of inoperable malignant tracheal obstruction Alaa Gaafar-MD, Ahmed Youssef-MD, Mohamed Elhadidi-MD A l e x a n d r i a F a c u l t y o f
More informationVideo-assisted thoracic surgery pneumonectomy: the first case report in Poland
Case report Videosurgery Video-assisted thoracic surgery pneumonectomy: the first case report in Poland Cezary Piwkowski, Piotr Gabryel, Mariusz Kasprzyk, Wojciech Dyszkiewicz Thoracic Surgery Department,
More informationJay B. Brodsky, M.D. Professor Department of Anesthesia tel: (650) Stanford University School of Medicine fax: (650)
Jay B. Brodsky, M.D. Professor Department of Anesthesia tel: (650) 725-5869 Stanford University School of Medicine fax: (650) 725-8544 Stanford, CA, 94305, USA e-mail: jbrodsky@stanford.edu RELIABLE SEPARATION
More informationTracheobronchial injuries (TBIs) are encountered with
Acute Injuries of the Trachea and Major Bronchi: Importance of Early Diagnosis David C. Cassada, MD, Mudiwa P. Munyikwa, MD, Mark P. Moniz, MD, Raymond A. Dieter, Jr, MD, George F. Schuchmann, MD, and
More informationSurgical Repair of Iatrogenic Cervical Tracheal Stenosis
Surgical Repair of Iatrogenic Cervical Tracheal Stenosis Nirmal K. Veeramachaneni, MD, and Bryan F. Meyers, MD, MPH he advent of intensive care unit management has increased the potential opportunities
More informationAdvances in MDCT of Thoracic Trauma
Baltic Congress of Radiology, Riga 2010 Advances in MDCT of Thoracic Trauma Robert A. Novelline, MD Professor of Radiology, Harvard Medical School Director of Emergency Radiology, Massachusetts General
More informationForeign Body Airway Obstructions in Children Lessons Learnt from a Prospective Audit
Foreign Body Airway Obstructions in Children Lessons Learnt from a Prospective Audit KL NARASIMHAN, SK CHOWDHARY, S SURI, JK MAHAJAN, R SAMUJH, KLN RAO Aim : To prospectively audit 75 consecutive children
More informationT ageal fistulas result from complications of mechanical
Management of Acquired Nonmalignant Tracheoesophageal Fistula Douglas J. Mathisen, MD, Hermes C. Grillo, MD, John C. Wain, MD, and Alan D. Hilgenberg, MD Department of Surgery, Massachusetts General Hospital,
More informationOperative Treatment of Massive Hemoptysis
Operative Treatment of Massive Hemoptysis Anatole Gourin, M.D., and Antonio A. Garzon, M.D. ABSTRACT Fifty-five pulmonary resections have been performed at our institution for hemoptysis of 600 ml. or
More informationManagement of Pediatric Tracheostomy
Management of Pediatric Tracheostomy Deepak Mehta Associate Professor Of Otolaryngology Director Pediatric Aerodigestive Center Definitions Tracheotomy: The making of an incision in the trachea The name
More informationCROSS CODER. Sample page. Anesthesia. codes to ICD-10-CM and HCPCS. Essential links from CPT. Power up your coding optum360coding.
CROSS CODER 2019 Anesthesia Essential links from CPT codes to ICD-10-CM and HCPCS Power up your coding optum360coding.com Contents Introduction...i CPT Anesthesia to Procedure Code Crosswalk... i Format...
More informationCHEST INJURIES. Jacek Piątkowski M.D., Ph. D.
CHEST INJURIES Jacek Piątkowski M.D., Ph. D. CHEST INJURIES 3-4% of all injuries 8% of patients hospitalized due to injuries 65% of patients who died at the accident place CLASSIFICATION OF THE CHEST INJURIES
More informationPenetrating Neck Injuries. Jason Levine MD Lutheran Medical Center July 22, 2010
Penetrating Neck Injuries Jason Levine MD Lutheran Medical Center July 22, 2010 CASE PRESENTATION 19 YO M 3 Stab Wounds Right zone I neck SW 2 SW anterior abdomen Left epigastrium anterior axillary line
More informationThe ABC s of Chest Trauma
The ABC s of Chest Trauma J Bradley Pickhardt MD, FACS Providence St Patrick Hospital What s the Problem? 2/3 of trauma patients have chest trauma Responsible for 25% of all trauma deaths Most injuries
More informationReview of Posttracheostomy And Postintubation Tracheal Stenosis With Special Regard to Etiology and Treatment
ISPUB.COM The Internet Journal of Thoracic and Cardiovascular Surgery Volume 6 Number 1 Review of Posttracheostomy And Postintubation Tracheal Stenosis With Special Regard to Etiology and A Sarper, A Ayten,
More informationPERFORATION OF THE TRACHEA AND BRONCHUS BY THE BRONCHOSCOPE
Thlorax (1950), 5, 369. PERFORATION OF THE TRACHEA AND BRONCHUS BY THE BRONCHOSCOPE BY Fronm the Regional Thoracic Surgery Centre, Shotley Bridge Hospital, Newcastle-upon-Tyne (RECEIVED FOR PUBLICATION
More informationSubglottic stenosis, with involvement of the lower larynx
Laryngotracheal Resection and Reconstruction John D. Mitchell, MD n, Subglottic stenosis is being recognized with increasing frequency in adults, and may be the most frequent indication for airway intervention
More informationMedian Sternotomy for Pneumonectomy in Patients With Pulmonary Complications of Tuberculosis
Median Sternotomy for Pneumonectomy in Patients With Pulmonary Complications of Tuberculosis Cliff P. Connery, MD, James Knoetgen III, MD, Constantine E. Anagnostopoulos, MD, and Madeline V. Svitak, BS,
More informationRight sleeve pneumonectomy via uniportal video-assisted thoracoscopic approach
Case Report Right sleeve pneumonectomy via uniportal video-assisted thoracoscopic approach Chenlu Yang, Firas Abu Akar, Jian Chen, Lei Jiang Department of Thoracic Surgery, Tongji University Affiliated
More informationNeonatal Airway Disorders, Treatments, and Outcomes. Steven Goudy, MD Pediatric Otolaryngology Emory University Medical Center
Neonatal Airway Disorders, Treatments, and Outcomes Steven Goudy, MD Pediatric Otolaryngology Emory University Medical Center Disclosure I have nothing to disclose Neonatal and Pediatric Tracheostomy Tracheostomy
More informationDisclosures. Learning Objectives. Coeditor/author. Associate Science Editor, American Heart Association
Tracheotomy Challenges for airway specialists Elizabeth H. Sinz, MD Professor of Anesthesiology & Neurosurgery Associate Dean for Clinical Simulation Disclosures Coeditor/author Associate Science Editor,
More informationDepartement of Surgery Faculty of Medicine University Sumatera Utara
SSS EESOPHAGEAL HPOSAGEAL DISORDERS IN SURGICAL PERSPECTIVE Departement of Surgery Faculty of Medicine University Sumatera Utara CONTENT 1. Esophageal Atresia 2. Achalasia 3. Esophageal Rupture 4. Tumor
More informationA new approach to left sleeve pneumonectomy: complete VATS left pneumonectomy followed by right thoracotomy for carinal resection and reconstruction
Fujino et al. Surgical Case Reports (2018) 4:91 https://doi.org/10.1186/s40792-018-0496-2 CASE REPORT A new approach to left sleeve pneumonectomy: complete VATS left pneumonectomy followed by right thoracotomy
More information4/24/2017. Tracheal Stenosis. Tracheal Stenosis. Tracheal Stenosis. Tracheal Stenosis. Tracheal Stenosis Endoscopic & Surgical Management
Endoscopic & Surgical Management Pressure ulceration Healing: granulation cicatrization contraction Ann Surg 1969;169:334-348 Gary Schwartz, MD Department of Thoracic Surgery and Lung Transplantation Baylor
More informationDUMON-NOVATECH Y-STENTS: A FOUR-YEAR EXPERIENCE WITH 50 TRACHEOBRONCHIAL TUMORS INVOLVING THE CARINA
Solunum 3, Özel Sayı 2: 260-264, 2001 DUMON-NOVATECH Y-STENTS: A FOUR-YEAR EXPERIENCE WITH 50 TRACHEOBRONCHIAL TUMORS INVOLVING THE CARINA Jean F DUMON* M C DUMON* SUMMARY This article reports a 4-year
More informationIndex. Note: Page numbers of article titles are in boldface type
Index Note: Page numbers of article titles are in boldface type A Acute coronary syndrome, perioperative oxygen in, 599 600 Acute lung injury (ALI). See Lung injury and Acute respiratory distress syndrome.
More informationsquamous-cell carcinoma1
Thorax (1975), 30, 152. Local ablative procedures designed to destroy squamous-cell carcinoma1 J. M. LEE, FREDERICK P. STITIK, DARRYL CARTER, and R. ROBINSON BAKER Departments of Surgery, Pathology, and
More informationUse of the Silicone T-tube to Treat Tracheal Stenosis or Tracheal Injury
Use of the Silicone T-tube to Treat Stenosis or Injury Chang-Jer Huang MD Backgound: stenosis or tracheal is a troublesome disease. Traditional temporary tracheostomy and reconstruction can resolve some
More informationProceedings of the World Small Animal Veterinary Association Mexico City, Mexico 2005
Close this window to return to IVIS Proceedings of the World Small Animal Veterinary Association Mexico City, Mexico 2005 Hosted by: Reprinted in the IVIS website with the permission of the WSAVA Surgery
More informationAcute Penetrating Tracheal Trauma
Acute Penetrating Tracheal Trauma Panagiotis N. Symbas, M.D., Charles R. Hatcher, Jr., M.D., and Gerhard A. W. Boehm, M.D. ABSTRACT During the past ten years, 20 patients with acute penetrating tracheal
More informationEmergency Approach to the Subclavian and Innominate Vessels
Emergency Approach to the Subclavian and Innominate Vessels Joseph J. Amato, M.D., Robert M. Vanecko, M.D., See Tao Yao, M.D., and Milton Weinberg, Jr., M.D. T he operative approach to an acutely injured
More informationIn ESH we usually see blunt chest trauma but penetrating injuries also treated here (usually as single injuries, like stab wound)
Chest Trauma Dr Csaba Dioszeghy MD PhD FRCEM FFICM FERC East Surrey Hospital Emergency Department Scope Thoracic injuries are common and can be life threatening In ESH we usually see blunt chest trauma
More informationParenchymal air leak is a frequent complication after. Pleural Tent After Upper Lobectomy: A Randomized Study of Efficacy and Duration of Effect
Pleural After Upper Lobectomy: A Randomized Study of Efficacy and Duration of Effect Alessandro Brunelli, MD, Majed Al Refai, MD, Marco Monteverde, MD, Alessandro Borri, MD, Michele Salati, MD, Armando
More informationDouble-lumen endotracheal tubes (DLTs) are used
Case Report 503 Tension Pneumothorax Complicated by Double-Lumen Endotracheal Tube Intubation Chia-Chun Huang, MD; An-Hsun Chou, MD; Hung-Pin Liu, MD; Chee-Yueu Ho, MD; Min-Wein Yun, MD Tension pneumothorax
More informationParenchyma-sparing lung resections are a potential therapeutic
Lung Segmentectomy for Patients with Peripheral T1 Lesions Bryan A. Whitson, MD, Rafael S. Andrade, MD, and Michael A. Maddaus, MD Parenchyma-sparing lung resections are a potential therapeutic option
More informationCase Report Reconstruction of Deep Posttraumatic Tracheal Stenosis while under Lung Assist
IBIMA Publishing International Journal of Case Reports in Medicine http://www.ibimapublishing.com/journals/ijcrm/ijcrm.html Vol. 2013 (2013), Article ID 540350, 5 pages DOI: 10.5171/2013.540350 Case Report
More informationDomino KB: Closed Malpractice Claims for Airway Trauma During Anesthesia. ASA Newsletter 62(6):10-11, 1998.
Citation Domino KB: Closed Malpractice Claims for Airway Trauma During Anesthesia. ASA Newsletter 62(6):1-11, 18. Full Text As experts in airway management, anesthesiologists are at risk for liability
More informationSETTING Fudan University Shanghai Cancer Center. RESPONSIBLE PARTY Haiquan Chen MD.
OFFICIAL TITLE A Phase Ⅲ Study of Left Side Thoracotomy Approach (SweetProcedure) Versus Right Side Thoracotomy Plus Midline Laparotomy Approach (Ivor-Lewis Procedure) Esophagectomy in Middle or Lower
More informationProceedings of the World Small Animal Veterinary Association Sydney, Australia 2007
Proceedings of the World Small Animal Sydney, Australia 2007 Hosted by: Next WSAVA Congress THE LAST GASP II: LUNGS AND THORAX David Holt, BVSc, Diplomate ACVS University of Pennsylvania School of Veterinary
More informationA Comparative Study of Video-Assisted Thoracic Surgery with Thoracotomy for Middle Lobe Syndrome
World J Surg (2017) 41:780 784 DOI 10.1007/s00268-016-3777-6 ORIGINAL SCIENTIFIC REPORT A Comparative Study of Video-Assisted Thoracic Surgery with Thoracotomy for Middle Lobe Syndrome Jian Li 1,2 Chengwu
More informationCase Report Reoperation for complicated tracheoesophageal fistula after surgery of a tracheal lymphoma
Int J Clin Exp Med 2017;10(6):9659-9663 www.ijcem.com /ISSN:1940-5901/IJCEM0051182 Case Report Reoperation for complicated tracheoesophageal fistula after surgery of a tracheal lymphoma Wei Dai 1, Qiang
More informationThoracoplasty for the Management of Postpneumonectomy Empyema
ISPUB.COM The Internet Journal of Thoracic and Cardiovascular Surgery Volume 9 Number 2 Thoracoplasty for the Management of Postpneumonectomy Empyema S Mullangi, G Diaz-Fuentes, S Khaneja Citation S Mullangi,
More informationThoracic anaesthesia. Simon May
Thoracic anaesthesia Simon May Contents Indications for lung isolation Ways of isolating lungs Placing a DLT Hypoxia on OLV Suitability for surgery Analgesia Key procedures Indications for lung isolation
More informationAlper Toker, MD. VATS decortication. Istanbul University, Istanbul Medical School Department of Thoracic Surgery
VATS decortication Alper Toker, MD Istanbul University, Istanbul Medical School Department of Thoracic Surgery Pleural space infection is a common pathology causing morbidity and mortality. It is a collection
More information90 th Annual Meeting The American Association for Thoracic Surgery May 1, 2010 Toronto, Ontario, Canada. Slide Tracheoplasty
90 th Annual Meeting The American Association for Thoracic Surgery May 1, 2010 Toronto, Ontario, Canada Congenital Skills Course Slide Tracheoplasty Carl Lewis Backer, MD A.C. Buehler Professor of Surgery
More informationSurgical treatment for patients with tracheal and subgllotic stenosis
Original Research Medical Journal of the Islamic Republic of Iran.Vol. 23, No. 3, November, 2009. pp. 132-138 Surgical treatment for patients with tracheal and subgllotic stenosis Mohammad Naeimi, MD.
More informationOriginal Article Percutaneous dilational tracheostomy: An initial experience in community based teaching hospital
Kathmandu University Medical Journal (2006), Vol. 4, No. 3, Issue 15, 275-280 Original Article Percutaneous dilational tracheostomy: An initial experience in community based teaching hospital Joshi S 1,
More informationTraumatic Tracheo-Oesophageal Fistula: A Case Study
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 12 Ver. II (Dec. 2017), PP 93-98 www.iosrjournals.org Traumatic Tracheo-Oesophageal Fistula:
More informationESTS SCHOOL OF THORACIC SURGERY Antalya Revisited in Istanbul March 2016 Istanbul, Turkey
ESTS SCHOOL OF THORACIC SURGERY Antalya Revisited in Istanbul 16-20 March 2016 Istanbul, Turkey Format 1. Lectures, Video and Case Presentations 15 min. 2. Learn from Peers Sessions. 3. More integrated
More informationDouble Y-stenting for tracheobronchial stenosis
ERJ Express. Published on April 10, 2012 as doi: 10.1183/09031936.00015012 Double Y-stenting for tracheobronchial stenosis M. Oki and H. Saka AFFILIATIONS Dept of Respiratory Medicine, Nagoya Medical Center,
More informationBronchogenic Carcinoma
A 55-year-old construction worker has smoked 2 packs of ciggarettes daily for the past 25 years. He notes swelling in his upper extremity & face, along with dilated veins in this region. What is the most
More informationCase report Esophageal lung: a rare case of communicating bronchopulmonary foregut malformation
Case report Esophageal lung: a rare case of communicating bronchopulmonary foregut malformation 1 Dr.Varsha Rathi, 2 Dr. Saurabh Deshpande*, 3 Dr.Almas Nazim, 4 Dr.Shilpa Domkundwar 1 Professor, Department
More informationInternational Journal of Scientific & Engineering Research, Volume 5, Issue 9, September ISSN
International Journal of Scientific & Engineering Research, Volume 5, Issue 9, September-2014 1196 Pneumomediastinum and subcutaneous emphysema secondary to blunt laryngeal traumafavourable outcome with
More informationLIST OF CLINICAL PRIVILEGES CARDIOTHORACIC SURGERY
LIST OF CLINICAL PRIVILEGES CARDIOTHORACIC SURGERY AUTHORITY: Title 10, U.S.C. Chapter 55, Sections 1094 and 1102. PRINCIPAL PURPOSE: To define the scope and limits of practice for individual providers.
More informationORIGINAL ARTICLE. Conservative Management of Iatrogenic Membranous Tracheal Wall Injury
ORIGINAL ARTICLE Conservative Management of Iatrogenic Membranous Tracheal Wall Injury A Discussion of 2 Successful Pediatric Cases Lauren C. Cunningham, MD; Kris R. Jatana, MD; Jonathan M. Grischkan,
More informationINDEPENDENT LUNG VENTILATION
INDEPENDENT LUNG VENTILATION Giuseppe A. Marraro, MD Director Anaesthesia and Intensive Care Department Paediatric Intensive Care Unit Fatebenefratelli and Ophthalmiatric Hospital Milan, Italy gmarraro@picu.it
More informationEvaluation & Management of Penetrating Wounds to the NECK
Evaluation & Management of Penetrating Wounds to the NECK Goal Effectively identify patients with a high probability of injury requiring surgical intervention Define the role of diagnostic tests in assessing
More informationMEDIASTINAL STAGING surgical pro
MEDIASTINAL STAGING surgical pro Paul E. Van Schil, MD, PhD Department of Thoracic and Vascular Surgery University of Antwerp, Belgium Mediastinal staging Invasive techniques lymph node mapping cervical
More informationJMSCR Volume 03 Issue 04 Page April 2015
www.jmscr.igmpublication.org Impact Factor 3.79 ISSN (e)-2347-176x A Rare Case of Boerhaaves Syndrome Managed Conservatively Authors Dr. Vinaya Ambore 1, Dr. Vikram Wagh 2, Dr. Prashant Turkar 3, Dr. Kapil
More informationChapter 124: Congenital Disorders of the Trachea. Bruce Benjamin
Chapter 124: Congenital Disorders of the Trachea Bruce Benjamin Investigation of the larynx and pharynx may be incomplete in infants and children with congenital abnormalities without investigation of
More informationCarinal resections. Leonidas Tapias, Michael Lanuti. Clinical vignette
Masters of Cardiothoracic Surgery Carinal resections Leonidas Tapias, Michael Lanuti Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA Correspondence to: Michael Lanuti, MD.
More informationThoracoscopic repair of esophageal atresia with a distal fistula lessons from the first 10 operations
Original paper Thoracoscopic repair of esophageal atresia with a distal fistula lessons from the first 10 operations Paweł Nachulewicz 1, Kamila Zaborowska 1, Błażej Rogowski 1, Anita Kalińska 1, Marzena
More informationNovatech Products for Interventional Pulmonology
Novatech Products for Novatech and Boston Medical Products Bringing you the finest products for Novatech is a manufacturer of top-quality medical products used successfully worldwide in the growing specialty
More informationUsing CT to Diagnose Tracheal Rupture
Jen-Dar Chen 1,2 Kathirkamanathan Shanmuganathan 2 Stuart E. Mirvis 2 Karen L. Killeen 2 Richard P. Dutton 3 Received July 3, 2000; accepted after revision October 25, 2000. 1 Department of Radiology,
More informationTrauma Activation 7/18/17
Blunt Rupture of the Thoracic Duct after Severe Thoracic Trauma Samuel Brown, MD Trauma Activation 7/18/17 53 year old male, rear end MVC, exited vehicle and was struck by a semi truck. Denies LOC, complaints
More informationPROFESORES EXTRANJEROS Vol. 32. Supl. 1, Abril-Junio 2009 pp S220-S226. Lung separation techniques for thoracic surgery. Peter Slinger MD, FRCPC*
medigraphic Artemisa en línea Anestesiología Mexicana de Revista ANTES C COLEGIO MEXICANO DE ANESTESIOLOGÍA A.C. SOCIEDAD MEXICANA DE ANESTESIOLOGÍA PROFESORES EXTRANJEROS Vol. 32. Supl. 1, Abril-Junio
More informationMassive subcutaneous emphysema after domestic fall
www.edoriumjournals.com CLINICAL IMAGES PEER REVIEWED OPEN ACCESS Massive subcutaneous emphysema after domestic fall Ida Carine Bø, Erik Waage Nielsen ABSTRACT Abstract is not required for Clinical Images
More informationArthroscopy has become a preferred diagnostic and
)459( COPYRIGHT 2017 BY THE ARCHIVES OF BONE AND JOINT SURGERY CASE REPORT Massive Emphysema and Pneumothorax Following Shoulder Arthroscopy under General Anaesthesia: A Case Report Mohammad j. shariyate,
More informationMarch The patients, two men and nine. an average of 54 years. In 10 of these patients. the cervical trachea was affected.
Thorax, 1978, 33, 378-386 Resection of thyroid carcinoma infiltrating the trachea T. ISHIHARA, K. KIKUCHI, T. IKEDA, H. INOUE, S. FUKAI, K. ITO', AND T. MIMURA' From the Department of Surgery, School of
More informationTrauma. Neck trauma zones. Neck Injuries 1/3/2018. Basic principles A ; Airway B ; Breathing C ; Circulation D ; Disability E ; Exposure
Trauma 45 minutes highest points Ahmed Mahmoud, MD Basic principles A ; Airway B ; Breathing C ; Circulation D ; Disability E ; Exposure Neck trauma zones Airway ;Rapid sequence intubation Breathing ;Needle
More information