Experience in Treating Patients with Instrumental Tracheal Rupture

RelevancE Instrumental tracheal ruptures (ITRs) are a rare but dangerous complication of invasive medical procedures. The lack of uniform diagnostic algorithms and treatment strategies, especially in patients requiring mechanical ventilation (MV), underscores the relevance of this study.

The aim of our study was to improve treatment outcomes for patients with instrumental tracheal injuries (ITIs).

Material and methods A retrospective and prospective analysis of 80 patients with ITI treated between 2003 and 2024 was conducted. The mean patient age was 52.2±11.4 years, and the majority of patients (87.5%) were women. Computed tomography (CT, n=60), tracheoscopy (n=55), and esophageal radiocontrast imaging/esophagoscopy (n=77) were used to diagnose instrumental tracheal ruptures. The sensitivity and specificity of the methods were assessed. Treatment included conservative and minimally invasive approaches (n=72), and surgical closure of the tracheal defect (n=8).

Results The  sensitivity  of  CT  for  diagnosing  tracheal  rupture  was  100%. All  spontaneously  breathing  patients  (n=53)  received  conservative  treatment; 14 patients requiring long-term mechanical ventilation were treated by positioning the endotracheal tube (ETT) cuff below the defect. Among patients on mechanical ventilation in whom the ETT cuff was placed below the rupture, healing occurred in 85.7% (12/14) of cases. For distal tracheal membranous wall ruptures, tracheal stenting with a bifurcation stent, and placement of the ETT cuff within the stent lumen was considered (n=4). In one case of distal tracheal rupture, the patient was transferred to spontaneous breathing with support from venovenous extracorporeal membrane oxygenation. Surgical treatment was used in 8 cases. The mortality rate in the conservative and minimally invasive treatment group was 8.3% (6/72), while in the surgical treatment group it was 50% (4/8). Overall mortality was 12.5% (10/80).

Conclusion 1. Computed tomography for tracheal ruptures is 100% sensitive, eliminating the need for routine tracheoscopy to confirm the diagnosis. Tracheoscopy is used to assess the parameters of rupture and reposition the endotracheal tube. 3. Conservative treatment is highly effective and is the treatment of choice. 4. Prioritizing conservative and endoscopic techniques over surgical ones significantly improved outcomes in patients on mechanical ventilation

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