New acute respiratory management in tracheal rupture caused by chest trauma
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(2020) 15:253
LETTER TO THE EDITOR
Open Access
New acute respiratory management in tracheal rupture caused by chest trauma Cheng Shen and Lin Ma* Abstract We report a case who is a 33-year-old man admitted to our Emergency room for chest trauma caused by the factory’s mechanical arm. Despite the endotracheal tube, the patient’s respiratory state was poor and the oxygen saturation did not improve and the subcutaneous emphysema progressed. To improve distressed breathing, we first proposed the concept “mechanical ventilation with dual ventilator” to maintain oxygen saturation of the patient. This is, to our knowledge, the first report of using a special mechanical ventilation method in emergency surgery. Keywords: Chest trauma, Tracheal rupture, Mechanical ventilation, Emergency surgery A 33-year-old man was admitted to our Emergency Room for chest trauma caused by the factory’s mechanical arm. He was a non-smoker. Physical examination revealed noticeable twist feeling under the skin of his neck, chest and abdomen. Plain chest computed tomography (CT) revealed suspected damage to the right tracheal membrane of patient (Fig. 1a and b, red arrow) and multiple fractures of the bilateral ribs, including the anterior branch of the left first and second ribs, and the posterior branch of the ribs in the right side (3th, 5th, 6th and 7th). It also showed soft tissue swelling and subcutaneous emphysema in neck, anterior chest wall, back and abdomen. Mediastinum emphysema and bilateral lung contusion were existing in chest CT obviously. On both sides of the chest, pneumothorax with pleural effusion and bilateral drainage tube shadows were seen in chest images. His oxygen saturation level decreased to 80%. However, due to the unstable condition of the patient and short time (less than 45 min) for organizational reason in Emergency room, especially the mediastinum and subcutaneous emphysema of the whole body were
* Correspondence: [email protected] Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu 610041, China
aggravated in short time, there was no more time to arrange bronchoscopy and gastroscopy. We approached the right chest via the thoracotomy with general anesthesia under double-lumen tube mechanical ventilation immediately. The patient’s respiratory state was poor, and gas analysis of the arterial blood revealed a pH of 7.29, pO2 of 50 mmHg, pCO2 of 51 mmHg, and 65% O2 saturation during the operation. Despite the endotracheal tube, the oxygen saturation did not improve and the subcutaneous emphysema progressed. Then we check the contralateral chest cavity through the anterior mediastinum to exclude the left pneumothorax for the suspicion on the chest tube occlusion. The main reason for poor oxygen saturation is severe left lung contusion. During intraoperative exploration and auxiliary observation by bronchoscope, we found that the tearing of tracheal membrane from the top of the right thorax down to the carina near the right main bronchus, and a 0.5*0.5 cm cavity was seen in the carina
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