Grewal et al reported indicators for various approaches in the treatment of a tracheal wall injury. The authors are from the Cleveland Clinic and Mount Sinai Health System in New York City.
Patient selection: tracheal injury
Management strategies:
(1) emergency/urgent surgery
(2) conservative therapy
(3) surgery after failure of conservative therapy
Indicators for emergency/urgent surgery:
(1) esophageal wall prolapse into the tracheobronchial lumen
(2) inability to ventilate
(3) intraoperative diagnosis of tracheobronchial injury
Indicators for conservative therapy:
(1) spontaneously breathing patients
(2) minimal mechanical ventilation
(3) no evidence of esophageal or mediastinal compromise
Indicators for surgery after failure of conservative therapy or not meeting criteria for conservative therapy:
(1) worsening of subcutaneous emphysema
(2) progressive pneumomediastinum
(3) pneumothorax with persistent air leak OR with failure of lung re-expansion despite chest tube placement
(4) clinical deterioration
(5) tracheal tears longer than 4 cm
Castillo level IIIA or IIIB injuries usually require surgery.
