Advertisement

Selective bilateral main stem bronchial intubation for the management of severe respiratory distress syndrome due to iatrogenic carinal perforation

  • Marina Di Gaetano
  • Federico MazzaEmail author
  • Enrico Ferrari
  • Paola Maineri
  • Giorgio Barabino
  • Giovanni Battista Ratto
Correspondence

To the Editor,

We report a case of tracheobronchial rupture (TBR) that occurred during mediastinoscopy and was further complicated by severe respiratory distress syndrome. The patient was conservatively treated by selective bilateral main stem bronchial intubation without tracheostomy. The patient gave written consent for publication of this article.

A 38-yr-old female was referred for enlarged mediastinal nodes without systemic symptoms. Bronchial biopsies were negative for malignant cells and mycobacterium tuberculosis(MTB) stain. The patient underwent mediastinoscopy; however, during the procedure, severe bleeding developed from the biopsied right lower paratracheal nodes and did not stop with tamponade. An attempt at hemostasis with electric coagulation resulted in a tear, 1 cm wide, involving the anterior lower tracheal and right main stem bronchial wall. The patient was hemodynamically stable without any respiratory impairment and her trachea was extubated and managed...

Keywords

Tracheal Wall Protective Ventilation Strategy Invasive Hemodynamic Monitoring Severe Respiratory Distress Syndrome Enlarge Mediastinal Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflicts of interest

None declared.

References

  1. 1.
    Beiderlinden M, Adamzik M, Peters J. Conservative treatment of tracheal injuries. Anesth Analg 2005; 100: 210-4.PubMedCrossRefGoogle Scholar
  2. 2.
    Gomez-Caro Andres A, Moradiellos Diez FJ, Ausin Herrero P, et al. Successful conservative management of iatrogenic tracheobronchial injury. Ann Thorac Surg 2005; 79: 1872-8.PubMedCrossRefGoogle Scholar
  3. 3.
    Conti M, Pougeoise M, Wurtz A, et al. Management of postintubation tracheobronchial ruptures. Chest 2006; 130: 412-8.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists' Society 2013

Authors and Affiliations

  • Marina Di Gaetano
    • 1
  • Federico Mazza
    • 2
    Email author
  • Enrico Ferrari
    • 3
  • Paola Maineri
    • 2
  • Giorgio Barabino
    • 1
  • Giovanni Battista Ratto
    • 3
  1. 1.Intensive Care UnitSanta Corona HospitalPietra LigureItaly
  2. 2.Thoracic Surgery UnitSanta Corona HospitalPietra LigureItaly
  3. 3.Thoracic Surgery UnitNational Cancer InstituteGenoaItaly

Personalised recommendations