Prokakis et al reviewed evaluation and management of a patient with airway trauma. The authors are from the University of Patras in Greece.
Early death may occur if there is airway obstruction, tension pneumothorax or ventilatory failure.
Clinical findings may be nonspecific and the diagnosis may be delayed. A patient with a delayed diagnosis may present with dyspnea or recurrent pneumonia secondary to airway stenosis and/or obstruction.
Imaging studies may show subcutaneous emphysema, pneumomediastinum and/or pneumothorax.
Chest CT with 3D reconstruction can be helpful in defining the defect.
Immediate management goals are control of the airway and appropriate ventilation. These can often be achieved with endotracheal intubation under bronchoscopic guidance.
Conservative management can be used if all of the following are present:
(1) a small injury (< 2 cm)
(2) a secure and patent airway
(3) adequate ventilation
(4) no signs of infection or sepsis
Surgical management (either repair with suture or resection with end-to-end anastomosis) is needed for major injuries or if the patient's presentation is delayed. Extensive circumferential mobilization around an injury can result of devascularization of the anastomosis with anastomotic dehiscence.
Some patients with a delayed presentation may require a bronchial sleeve resection or partial lobectomy. The viability of lung parenchyma should be determined at the time of surgery in order to avoid unnecessary resection of viable lung tissue.
