Affiliation:
1. Vanderbilt University Medical Center, Nashville, TN, USA
2. University of North Carolina at Chapel Hill, NC, USA
3. Outcomes Research Consortium, Cleveland, OH, USA
Abstract
Tracheal laceration during cardiac surgery is a rarely reported form of iatrogenic tracheal injury. During dissection prior to sternotomy, the interclavicular ligament must be divided. This structure overlies the proximal trachea, predisposing the trachea to injury at this location. Challenges related to tracheal laceration in cardiac surgery include patients with already tenuous cardiopulmonary status, surgical positioning that increases the risk of injury, obscured traditional clinical findings causing delayed recognition, increased risk of mediastinitis, and a heightened risk of airway fire. The incidence, mechanism, and ideal management of sternotomy-related tracheal injury, though a life-threatening complication, is rarely described in the literature. Consensus is lacking regarding the necessity and timing of tracheal repair versus conservative management, whether to proceed with the initially planned procedure, and the optimal timing of airway exchange in the event of endotracheal tube cuff rupture. In this article, we present the management of a full-thickness thermal tracheal injury due to electrocautery, resulting in a large air leak treated with delayed endotracheal tube exchange and tracheal repair after cardiopulmonary bypass.
Subject
Anesthesiology and Pain Medicine,Cardiology and Cardiovascular Medicine
Cited by
2 articles.
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1. Tracheal Injury Complicating Mitral Valve Repair;Journal of Cardiothoracic and Vascular Anesthesia;2020-06
2. Managing Critical Events During Cardiothoracic and Transplant Surgery;Seminars in Cardiothoracic and Vascular Anesthesia;2019-08-11