Management of blunt tracheobronchial trauma in the pediatric age group
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ORIGINAL ARTICLE
Management of blunt tracheobronchial trauma in the pediatric age group Q. Ballouhey • R. Fesseau • V. Benouaich • S. Lagarde S. Breinig • B. Le´obon • P. Galinier
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Received: 17 November 2012 / Accepted: 27 December 2012 / Published online: 8 January 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Introduction Tracheobronchial rupture (TBR) due to blunt chest trauma is a rare but life-threatening injury in the pediatric age group. The aim of this study was to propose a treatment strategy including bronchoscopy, surgery and extracorporeal membrane oxygenation (ECMO) to optimize the emergency management of these patients. Methods We reviewed a series of 27 patients with posttraumatic TBR treated since 1996 in our pediatric trauma center. Results Seven cases had persistent and large volume air leaks. Flexible bronchoscopy was performed in cases of Q. Ballouhey (&) P. Galinier Department of Pediatric Surgery, Children’s Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059 Toulouse Cedex 9, France e-mail: [email protected]
persistent or large volume air leaks. It permitted accurate visualization of the rupture and its extent. It allowed for a clear-cut positioning of the endotracheal tube. Five were managed operatively. Four cases were considered to be life-threatening because of the combination of severe respiratory distress with hemodynamic instability. One of them had severe tracheal laceration and died. Another one had bilateral bronchi disconnection. Based on clinical and endoscopic findings, surgical repair was performed using extracorporeal membrane oxygenation as a ventilatory support. It provided quick relief from the injury, which was previously expected to result in a fatal issue. Conclusions Prompt diagnosis and accurate management of surviving patients admitted to emergency rooms are necessary. Bronchoscopy remains a critical diagnosis step. Surgery is warranted for large tracheobronchial tears and ECMO could be beneficial as supportive therapy for selected cases.
R. Fesseau Department of Pediatric Anesthesiology, Children’s Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059 Toulouse Cedex 9, France
Keywords Tracheobronchial trauma Children Bronchoscopy ECMO
V. Benouaich Department of Cardiac Surgery, Rangueil Hospital, 1 Av J. Poulhes, 31059 Toulouse Cedex 9, France
Introduction
S. Lagarde Department of Radiology, Rangueil Hospital, 1 Av J. Poulhes, 31059 Toulouse Cedex 9, France S. Breinig Pediatric Intensive Care Unit, Children’s Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059 Toulouse Cedex 9, France B. Le´obon Department of Pediatric Cardiac Surgery, Children’s Hospital, 330 Avenue de Grande-Bretagne TSA 70034, 31059 Toulouse Cedex 9, France
Tracheobronchial ruptures (TBR) are rare in the pediatric age group [1]. They are defined as life-threatening ruptures of the trachea or bronchi localized between the level of the cricoid cartilage and the division of the lobar bronchi into their segmental branches [2]. The vast majority of blunt trach
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