OBJECTIVES: Iatrogenic injuries to the trachea are rare, but life-threatening complaints. Causes and treatment methods have been described for adults, but there is no literature on aetiology and treatment in children. We performed a retrospective study to examine the frequency, aetiology, and treatment of iatrogenic injuries to the trachea in children and to develop guidelines for their treatment and prevention. METHODS: Retrospective study from 2000-2007 at a level I trauma centre. All iatrogenic injuries to the trachea between the cricoid cartilage and the level of the carina in children (ages 0-16) were included in the study. RESULTS: Between 2000 and 2007, 18 tracheal injuries were treated, four of them in children (22%). The primary symptom in all cases was emphysema. Diagnosis was confirmed using flexible endoscopy. In all cases, the cause of the injury was intubation. Two cases of acute injury were treated conservatively by bridging the injury with a tube. Two cases were treated surgically by means of end-to-end anastomosis. In all cases, healing by first intention occurred. No stenoses were observed during follow-up endoscopy. CONCLUSIONS: Acute tracheal ruptures in children can be treated conservatively by bridging the rupture with a tube. Injuries to the trachea in which the mucosa is damaged or in which other complications, such as fistulae, are present must be treated surgically. The prognosis for such injuries is good.
OBJECTIVES:Iatrogenic injuries to the trachea are rare, but life-threatening complaints. Causes and treatment methods have been described for adults, but there is no literature on aetiology and treatment in children. We performed a retrospective study to examine the frequency, aetiology, and treatment of iatrogenic injuries to the trachea in children and to develop guidelines for their treatment and prevention. METHODS: Retrospective study from 2000-2007 at a level I trauma centre. All iatrogenic injuries to the trachea between the cricoid cartilage and the level of the carina in children (ages 0-16) were included in the study. RESULTS: Between 2000 and 2007, 18 tracheal injuries were treated, four of them in children (22%). The primary symptom in all cases was emphysema. Diagnosis was confirmed using flexible endoscopy. In all cases, the cause of the injury was intubation. Two cases of acute injury were treated conservatively by bridging the injury with a tube. Two cases were treated surgically by means of end-to-end anastomosis. In all cases, healing by first intention occurred. No stenoses were observed during follow-up endoscopy. CONCLUSIONS: Acute tracheal ruptures in children can be treated conservatively by bridging the rupture with a tube. Injuries to the trachea in which the mucosa is damaged or in which other complications, such as fistulae, are present must be treated surgically. The prognosis for such injuries is good.
Authors: Sanjay Chawla; Girija Natarajan; Seetha Shankaran; Benjamin Carper; Luc P Brion; Martin Keszler; Waldemar A Carlo; Namasivayam Ambalavanan; Marie G Gantz; Abhik Das; Neil Finer; Ronald N Goldberg; C Michael Cotten; Rosemary D Higgins Journal: J Pediatr Date: 2017-06-07 Impact factor: 4.406