The risk of a penetrating injury of the tracheobronchial wall is affected by a number of factors.

Demographic risk factors:

(1) age > 65 years

(2) female sex


Anatomic risk factors:

(1) congenital tracheal diverticulum

(2) tracheal distortion (from neoplasm or other cause)

(3) Mounier-Kuhn syndrome (tracheobronchomegaly)

(4) tracheal inflammation

(5) tracheal bronchus


Procedural risk factors for iatrogenic injury:

(1) inexperienced operator

(2) multiple/repeated attempts at intubation, especially if forceful (difficult intubation)

(3) use of a stylet during intubation

(4) incorrect tracheal tube size

(5) double-lumen tube

(6) poor postintubation care

(7) high balloon diameter during bronchoplasty

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