Isolated Bronchial Injury: A Diagnostic and Management Challenge
The injuries of major airways in high speed motor vehicle accidents are a relatively uncommon with a reported incidence of 0.03%-3% [1-3].Besides blunt chest injuries, the presence of associated other multiple injuries (head, facial, spine, abdomen, vascular and orthopaedic) are important determinants of outcome In 25% of cases, deaths are due to thoracic trauma. The airway injury is mostly fatal and it is reported that a large proportion (81%) of the airway injury patients died immediately or before reaching the hospital due to tension pneumothorax. The incidence of trachea-bronchial tree injury is 0.5% in blunt trauma and 1-2% in penetrating trauma. Isolated major bronchial injury without any other major organ or vascular injury in blunt chest trauma is rare. Most of injuries due to blunt trauma involveintra-thoracic trachea or main stem bronchi. Diagnosis is delayed in25-68% of the patients.
Airway injuries may escape diagnosis due to distal intubation done to stabilize the patient with multiple injuries or they may not be clinically suspected initially. A detailed clinical examination must be done for a prompt diagnosis based on the critical symptoms in the patients who arrive alive in the hospital .Diagnostic modalities include clinical, radiological and bronchoscopicexaminations. Efficient management of the airway with early surgical repair is the key for excellent recovery. Respiratory failure can occur if diagnosis is missed or delayed. The aim of the present study is to gain an insight into the diverse clinical spectrum of isolated blunt bronchial injuries.
Isolated blunt bronchial trauma is a rare but serious and potentially fatal injury. Diagnosis is difficult and a missed diagnosis is common due to nonspecific clinical presentation. Therefore, in blunt chest trauma prompt recognition of the airway injury is crucial for early surgical intervention. Important factor for determining the outcome in bronchial trauma is the presence of other associated injuries. Prompt airway management and early repair can greatly improve the chances of restoring normal pulmonary functions.
Journal of Surgery and Anesthesia.
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