Tracheobronchial rupture is an extremely rare and potentially fatal complication. We present the case of a delayed presentation of an iatrogenic tracheobronchial rupture following orotracheal intubation, requiring veno-venous extracorporeal membrane oxygenator on standby. We review the clinical presentation, investigations, and management of tracheobronchial rupture, including conservative treatment and invasive surgical repair techniques.

UNASSIGNED: Tracheal injury may be a rare complication of the endotracheal intubation procedure. Incidence and determinant factors are not well known, nevertheless a greater incidence have been recognized with a difficult maneuver or the use of nitrogen peroxide. The therapeutic approach can be conservative or surgical, depending on the characteristics of the lesion and of the patient and therefore the outcomes of medico-legal interest can be different.
UNASSIGNED: It is a case of alleged medical liability regarding a 70-year-old woman, that during the intubation procedure was pouncing on the right. Furthermore, nitrous oxide was used as an anaesthetic. A few hours after the operation the patient showed swelling on the right half of the face and on the right lateral region of the neck. The emergency chest CT scan highlighted subcutaneous emphysema and pneumomediastinum. In the operating room, fibrobronchoscopy was performed with a double-lumen bronchial tube which confirmed the hypotheses lesion; then, right posterolateral thoracotomy was perfor-med followed by suturing of the tracheal lesion. Subsequently, the patient was discharged in good clinical conditions but with a scar in the region of the right hemithorax.
UNASSIGNED: Iatrogenic tracheal injury is a rare and fearful complication of the orotracheal intubation procedure. Although risk factors that increase the probability of its onset have been recognized, in most cases it is not possible to identify the cause. From a medico-legal point of view, tracheal injury after intubation is unpredictable and inevitable, so in the case reported it was decided to proceed with a conciliatory solution.

UNASSIGNED: Traumatic tracheobronchial injury is a rare manifestation after blunt chest injury. The current standard treatment has wide spectrum from conservative treatment to open thoracotomy with repair airway regarding to severity of the disease. However, to the best of our knowledge, no one has reported airway repair in trauma using video-assisted thoracoscopic surgery (VATS) before. Hence, we describe the successful management and repair of a transected right main bronchus using VATS.
UNASSIGNED: A 43-year-old male patient presented with chest tightness after a traumatic blunt chest injury; a chest computed tomography revealed multiple rib fractures and suspected right main bronchus injury with large pneumomediastinum and subcutaneous emphysema. Although the current standard treatment is to perform open thoracotomy with tracheal repair, we performed VATS repair of right main bronchus in purpose to reduce the stress from tissue trauma and minimally invasive fashion. Emergency surgery was scheduled for injury repair, and the transected right main stem bronchus and mediastinum hematoma were intraoperatively identified. The right main bronchus was repaired using polypropylene 4-0 interrupted sutures under uniportal VATS and covered with pericardial fat pad tissue. After the surgery, the patient had no air leak from chest tube drainage and recovered well. The patient was performed diagnostic bronchoscopy to confirm the patent airway at day 3 then discharged 7 days after surgery and was doing well at a 1-month follow-up.
UNASSIGNED: VATS repair is safe and feasible as an alternative approach to conventional thoracotomy approach in the treatment of traumatic tracheobronchial injury.

Iatrogenic injuries of the esophagus and trachea are rare. However, these are life-threatening events due to severe complications. The authors report iatrogenic perforation of cervical esophagus with a long false passage in posterior mediastinum in an 83-year-old patient undergoing endoscopic retrograde cholangiopancreatography for choledocholithiasis. Post-intubation rupture of thoracic trachea was diagnosed early after suturing the defect of esophagus and drainage of mediastinum. Treatment strategy was analyzed and conservative management of tracheal injury was substantiated.
Ятрогенные повреждения пищевода и трахеи встречаются относительно редко, вместе с тем они имеют жизнеугрожающий характер из-за развития тяжелых осложнений. Представлено клиническое наблюдение инструментальной перфорации шейного отдела пищевода с протяженным ложным ходом в заднем средостении у 83-летней пациентки в результате попытки выполнить эндоскопическую ретроградную холангиопанкреатографию в связи с холедохолитиазом. В ранние сроки после ушивания дефекта пищевода и дренирования средостения диагностирован постинтубационный разрыв грудного отдела трахеи. Проанализирована лечебная тактика и обосновано консервативное ведение травмы трахеи.

Tracheobronchial injury (TBI) associated with penetrating injuries has various clinical symptoms and often requires urgent surgical repair. A tracheal tube and/or placement of a drainage tube combined with multidetector computed tomography (CT) could be used to manage TBI without surgical repair in eligible patients. In this case report, we describe an 86-year-old woman with subcutaneous emphysema and suspected TBI caused by three knife wounds in her neck. After tracheal intubation at a local hospital, she was transferred to our hospital. On admission, she was diagnosed with subcutaneous and mediastinal emphysema due to TBI, as well as bilateral pneumothorax. We adjusted the position of the tracheal tube to a distal location from the TBI, and placed bilateral thoracic drainage tubes by referring to the CT images taken on admission and during the follow-up. The follow-up CT images revealed healing of the TBI. She did not show any worsening of her symptoms and she was successfully extubated on day 10 of her hospital stay. On day 18, she was considered self-reliant and was transferred to her previous hospital. Based on our experience in this case, we believe that ventilation with appropriate sedation, placement of a tracheal tube, and drainage are important conservative therapies for TBI caused by penetrating injuries. CT is also useful for evaluating the status of TBI.

The authors report an attempt of tracheal stenosis bougienage complicated by tracheal rupture. Particularities of diagnosis and treatment of patients with cicatricial stenoses of breathing pathways are analyzed.
Описано наблюдение попытки бужирования стеноза трахеи, осложненной ее разрывом, проанализированы особенности диагностики и лечения пациентов с рубцовыми сужениями дыхательных путей.

OBJECTIVE: Iatrogenic tracheal rupture is an unusual and severe complication that can be caused by tracheal intubation. The frequency, management, and outcome of iatrogenic tracheal rupture due to prehospital emergency intubation in adults by emergency response physicians has not yet been sufficiently explored.
METHODS: Adult patients with iatrogenic tracheal ruptures due to prehospital emergency intubation admitted to an academic referral center over a 15-year period (2004-2018) with consideration of individual risk factors were analyzed.
RESULTS: Thirteen patients (eight female) with a mean age of 67 years met the inclusion criteria and were analyzed. Of these, eight tracheal ruptures (62%) were caused during the airway management of cardiopulmonary resuscitation (CPR). Stylet use and difficult laryngoscopy requiring multiple attempts were documented in eight cases (62%) and four cases (30%), respectively. Seven patients (54%) underwent surgery, while six patients (46%) were treated conservatively. The overall 30-day mortality was 46%; five patients died due to their underlying emergencies and one patient died of tracheal rupture. Three survivors (23%) recovered with severe neurological sequelae and four (30%) were discharged in good neurological condition. Survivors had significantly smaller mean rupture sizes (2.7cm versus 6.3cm; P <.001) and less cutaneous emphysema (n = 2 versus n = 6; P = .021) than nonsurvivors.
CONCLUSIONS: Iatrogenic tracheal rupture due to prehospital emergency intubation is a rare complication. Published risk factors are not consistently present and may not be applicable to identify patients at high risk, especially not in rescue situations. Treatment options depend on individual patient condition, whereas outcome largely depends on the underlying disease and rupture extension.

UNASSIGNED: This paper presents the case of a traumatic tracheal rupture in a pediatric patient. The body of literature of the clinical features, evaluation, and management of this uncommon presentation is discussed.
UNASSIGNED: A 13-year-old boy sustained an intrathoracic tracheal rupture whilst playing Australian Rules football. He developed hallmark clinical features of air extravasation and was intubated prior to transfer to a tertiary pediatric center for further management. After a short trial of conservative management, his respiratory status deteriorated and he was taken to the operating theater for open surgical repair of the defect.
UNASSIGNED: Traumatic rupture of the trachea is a rare injury in children. This case demonstrates the dynamic nature of this serious injury and the need for multidisciplinary care in achieving the optimal outcome.

OBJECTIVE: To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients.
CONCLUSIONS: In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).

OBJECTIVE: To assess the tracheal elasticity and tracheal anastomosis tension for prevention of anastomosis-related complications and estimation of the maximum length of resection.
METHODS: At the first stage, 20 patients with cicatricial tracheal stenosis underwent tracheoscopy in usual position, under maximum flexion and extension of the head for the period from September 2017 to December 2019. We measured the total length of trachea and length of stenotic segment. Tracheal extensibility was assessed considering the difference in measurements. At the second stage, anastomosis tension was intraoperatively measured using a dynamometer in normal head position, as well as at maximum flexion in 22 patients who underwent tracheal resection. Unlike multiple other studies, we studied tissue tension intraoperatively.
RESULTS: Mean length of trachea was 12.8 cm, extensibility - 1.3 cm. Tracheal elasticity was greater in patients with a longer trachea and in patients under 40 years old. Mean length of resection was 3.9 cm (30% of mean length of trachea), anastomosis tension - 2.7 H or 270 g. Head flexion was followed by tension decrease by 0.7 H (26.9%), i.e. 70 g. This approach is less effective in case of resection of more than 30% of trachea length in a particular patient.
CONCLUSIONS: Further experience in measurement of tracheal extensibility and anastomosis tension will make it possible to establish clinical significance of these indicators for prevention of complications.
UNASSIGNED: Оценить эластичность трахеи и измерить натяжение тканей на анастомозе трахеи с целью профилактики осложнений со стороны трахеального анастомоза и определения максимальной протяженности резекции.
UNASSIGNED: С сентября 2017 по декабрь 2019 г. в Сеченовском университете на первом этапе исследования 20 пациентам с подтвержденным диагнозом рубцового стеноза трахеи выполнена фибротрахеоскопия в обычном положении, в положении максимального сгибания и разгибания головы. При этом измеряли общую длину трахеи у конкретного пациента и протяженность стенозированного участка. О степени растяжимости трахеи косвенно судили по разнице результатов измерения. На втором этапе 22 пациентам, которым выполнили резекцию трахеи, во время операции исследовали силу натяжения тканей на анастомозе при помощи динамометра сжатия—растяжения в обычном положении головы, а также при максимальном сгибании. В отличие от многих других исследований мы изучали степень натяжения тканей во время операции, при жизни больного.
UNASSIGNED: Длина трахеи в среднем составила 12,8 см, ее растяжимость составила 1,3 см. Эластичность трахеи больше у пациентов с более длинной трахеей и у пациентов моложе 40 лет. Средняя протяженность резекции составмла 3,9 см (30% средней длины трахеи), натяжение на анастомозе — 2,7 Н, или 270 г. При приведении головы к передней грудной стенке натяжение на анастомозе в среднем уменьшалось на 0,7 Н (на 26,9%), т.е. на 70 г. При резекции более 30% длины трахеи конкретного пациента эффективность такого приема снижается.
UNASSIGNED: Накопление опыта по определению растяжимости трахеи и степени натяжения тканей на анастомозе в дальнейшем позволит установить клиническую значимость этих показателей для профилактики осложнений трахеального анастомоза.