The tracheobronchial tree can be injured by blunt or penetrating injury. Some injuries can be managed conservatively, while others require operative repair.


Criteria for conservative (nonoperative) management – all of the following:

(1) small tracheobronchial laceration(s)

(2) injury involves less than one third of the circumference of the airway

(3) the edges of the injury are well-opposed

(4) there is no tissue loss

(5) there are no other associated injuries

(6) positive pressure ventilation is not required


Management if conservative approach:

(1) humidify air

(2) voice rest

(3) frequent suctioning

(4) prophylactic antibiotics

(5) proton pump inhibitor

(6) close observation, with follow-up bronchoscopy


If one or more of the criteria are not met, then operative repair is indicated, which involves:

(1) debriding damaged tissue and evacuate any hematoma

(2) end-to-end anastomosis, tension free and with preservation of blood supply

(3) continuous running sutures using monofilament sutures, with knots on the outside


To read more or access our algorithms and calculators, please log in or register.