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.

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