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Copyright (c) 2025 Guoom Gazam Mohamad Alenezi, Mohammed Ali Ali Nushayli, Mohammed Ahmed Yahya Ghazwani, Mohammed Ahmad Rajhi, Yahya Ali Jaber Nushayli, Majed Mohammed Ali Sowedi, Mohammed Ali Mohammed Mobarki, Yahya Alawi Yahya Dibaji, Yahay Mohammed Ali Awaji, Faisal Fahad Ali Aljahlan, Ibrahim Mohammed Agili, Abdo Hassan Mohammed Khobrani, Raad Ibrahim Muqri
This work is licensed under a Creative Commons Attribution 4.0 International License.
Tracheobronchial Tear in Emergency Care: Rapid Recognition, Airway Stabilization, and Definitive Management Strategies
Corresponding Author(s) : Guoom Gazam Mohamad Alenezi
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Tracheobronchial tear is a rare but life-threatening airway injury resulting from blunt or penetrating trauma or iatrogenic interventions. Its diagnostic challenge and high mortality underscore the need for rapid recognition and effective management.
Aim: To review the etiology, epidemiology, pathophysiology, diagnostic strategies, and management principles of tracheobronchial tears in emergency care settings.
Methods: A comprehensive literature-based analysis was conducted, synthesizing evidence from trauma registries, postmortem studies, and clinical series. Mechanisms of injury, diagnostic modalities, and treatment approaches were examined to identify best practices for emergency and perioperative care.
Results: Tracheobronchial injuries occur predominantly near the carina and main bronchi, with blunt trauma associated with higher mortality than penetrating injuries. Up to 70% of cases are initially missed, often presenting with nonspecific signs such as persistent pneumothorax and subcutaneous emphysema. Fiberoptic bronchoscopy remains the gold standard for diagnosis and airway stabilization. Definitive management typically involves surgical repair, although conservative and endoscopic strategies are viable for select iatrogenic injuries. Prognosis improves significantly with early recognition and multidisciplinary intervention.
Conclusion: Early suspicion, bronchoscopy-guided airway control, and mechanism-sensitive management are critical to reducing morbidity and mortality. Structured trauma protocols and preventive measures for iatrogenic injury can further enhance outcomes.
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- Ecker RR, Libertini RV, Rea WJ, Sugg WL, Webb WR. Injuries of the trachea and bronchi. The Annals of thoracic surgery. 1971 Apr:11(4):289-98
- Kummer C, Netto FS, Rizoli S, Yee D. A review of traumatic airway injuries: potential implications for airway assessment and management. Injury. 2007 Jan:38(1):27-33
- Karmy-Jones R, Wood DE. Traumatic injury to the trachea and bronchus. Thoracic surgery clinics. 2007 Feb:17(1):35-46
- Nelson LA. Airway trauma. International anesthesiology clinics. 2007 Summer:45(3):99-118
- Kiser AC, O'Brien SM, Detterbeck FC. Blunt tracheobronchial injuries: treatment and outcomes. The Annals of thoracic surgery. 2001 Jun:71(6):2059-65
- Welter S. Repair of tracheobronchial injuries. Thoracic surgery clinics. 2014 Feb:24(1):41-50. doi: 10.1016/j.thorsurg.2013.10.006.
- Miñambres E, Burón J, Ballesteros MA, Llorca J, Muñoz P, González-Castro A. Tracheal rupture after endotracheal intubation: a literature systematic review. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2009 Jun:35(6):1056-62. doi: 10.1016/j.ejcts.2009.01.053.
- Johnson SB. Tracheobronchial injury. Seminars in thoracic and cardiovascular surgery. 2008 Spring:20(1):52-7. doi: 10.1053/j.semtcvs.2007.09.001.
- Bertelsen S, Howitz P. Injuries of the trachea and bronchi. Thorax. 1972 Mar:27(2):188-94
- Rossbach MM, Johnson SB, Gomez MA, Sako EY, Miller OL, Calhoon JH. Management of major tracheobronchial injuries: a 28-year experience. The Annals of thoracic surgery. 1998 Jan:65(1):182-6
- Symbas PN, Justicz AG, Ricketts RR. Rupture of the airways from blunt trauma: treatment of complex injuries. The Annals of thoracic surgery. 1992 Jul:54(1):177-83
- Schneider T, Volz K, Dienemann H, Hoffmann H. Incidence and treatment modalities of tracheobronchial injuries in Germany. Interactive cardiovascular and thoracic surgery. 2009 May:8(5):571-6. doi: 10.1510/icvts.2008.196790.
- Massard G, Rougé C, Dabbagh A, Kessler R, Hentz JG, Roeslin N, Wihlm JM, Morand G. Tracheobronchial lacerations after intubation and tracheostomy. The Annals of thoracic surgery. 1996 May:61(5):1483-7
- Borasio P, Ardissone F, Chiampo G. Post-intubation tracheal rupture. A report on ten cases. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 1997 Jul:12(1):98-100
- Grewal HS, Dangayach NS, Ahmad U, Ghosh S, Gildea T, Mehta AC. Treatment of Tracheobronchial Injuries: A Contemporary Review. Chest. 2019 Mar:155(3):595-604. doi: 10.1016/j.chest.2018.07.018.
- Parekh K, Iannettoni MD. Complications of esophageal resection and reconstruction. Seminars in thoracic and cardiovascular surgery. 2007 Spring:19(1):79-88
- Juvekar NM, Deshpande SS, Nadkarni A, Kanitkar S. Perioperative management of tracheobronchial injury following blunt trauma. Annals of cardiac anaesthesia. 2013 Apr-Jun:16(2):140-3. doi: 10.4103/0971-9784.109772.
- Herrmann D, Volmerig J, Al-Turki A, Braun M, Herrmann A, Ewig S, Hecker E. Does less surgical trauma result in better outcome in management of iatrogenic tracheobronchial laceration? Journal of thoracic disease. 2019 Nov:11(11):4772-4781. doi: 10.21037/jtd.2019.10.22.
- de Lesquen H, Avaro JP, Gust L, Ford RM, Beranger F, Natale C, Bonnet PM, D'Journo XB. Surgical management for the first 48 h following blunt chest trauma: state of the art (excluding vascular injuries). Interactive cardiovascular and thoracic surgery. 2015 Mar:20(3):399-408. doi: 10.1093/icvts/ivu397.
- Jougon J, Ballester M, Choukroun E, Dubrez J, Reboul G, Velly JF. Conservative treatment for postintubation tracheobronchial rupture. The Annals of thoracic surgery. 2000 Jan:69(1):216-20
- Gómez-Caro A, Ausín P, Moradiellos FJ, Díaz-Hellín V, Larrú E, Pérez JA, de Nicolás JL. Role of conservative medical management of tracheobronchial injuries. The Journal of trauma. 2006 Dec:61(6):1426-34; discussion 1434-5
- Cardillo G, Carbone L, Carleo F, Batzella S, Jacono RD, Lucantoni G, Galluccio G. Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non-surgical treatment. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2010 Mar:37(3):581-7. doi: 10.1016/j.ejcts.2009.07.034.
- Lee SK, Kim DH, Lee SK, Kim YD, Cho JS, I H. Does Surgical Repair Still have a Role for Iatrogenic Tracheobronchial Rupture? Clinical Analysis of a Thoracic Surgeon's Opinion. Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 2016 Dec 20:22(6):348-353. doi: 10.5761/atcs.oa.16-00189.
- Madden BP. Evolutional trends in the management of tracheal and bronchial injuries. Journal of thoracic disease. 2017 Jan:9(1):E67-E70. doi: 10.21037/jtd.2017.01.43.
- Prokakis C, Koletsis EN, Dedeilias P, Fligou F, Filos K, Dougenis D. Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. Journal of cardiothoracic surgery. 2014 Jun 30:9():117. doi: 10.1186/1749-8090-9-117.
References
Ecker RR, Libertini RV, Rea WJ, Sugg WL, Webb WR. Injuries of the trachea and bronchi. The Annals of thoracic surgery. 1971 Apr:11(4):289-98
Kummer C, Netto FS, Rizoli S, Yee D. A review of traumatic airway injuries: potential implications for airway assessment and management. Injury. 2007 Jan:38(1):27-33
Karmy-Jones R, Wood DE. Traumatic injury to the trachea and bronchus. Thoracic surgery clinics. 2007 Feb:17(1):35-46
Nelson LA. Airway trauma. International anesthesiology clinics. 2007 Summer:45(3):99-118
Kiser AC, O'Brien SM, Detterbeck FC. Blunt tracheobronchial injuries: treatment and outcomes. The Annals of thoracic surgery. 2001 Jun:71(6):2059-65
Welter S. Repair of tracheobronchial injuries. Thoracic surgery clinics. 2014 Feb:24(1):41-50. doi: 10.1016/j.thorsurg.2013.10.006.
Miñambres E, Burón J, Ballesteros MA, Llorca J, Muñoz P, González-Castro A. Tracheal rupture after endotracheal intubation: a literature systematic review. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2009 Jun:35(6):1056-62. doi: 10.1016/j.ejcts.2009.01.053.
Johnson SB. Tracheobronchial injury. Seminars in thoracic and cardiovascular surgery. 2008 Spring:20(1):52-7. doi: 10.1053/j.semtcvs.2007.09.001.
Bertelsen S, Howitz P. Injuries of the trachea and bronchi. Thorax. 1972 Mar:27(2):188-94
Rossbach MM, Johnson SB, Gomez MA, Sako EY, Miller OL, Calhoon JH. Management of major tracheobronchial injuries: a 28-year experience. The Annals of thoracic surgery. 1998 Jan:65(1):182-6
Symbas PN, Justicz AG, Ricketts RR. Rupture of the airways from blunt trauma: treatment of complex injuries. The Annals of thoracic surgery. 1992 Jul:54(1):177-83
Schneider T, Volz K, Dienemann H, Hoffmann H. Incidence and treatment modalities of tracheobronchial injuries in Germany. Interactive cardiovascular and thoracic surgery. 2009 May:8(5):571-6. doi: 10.1510/icvts.2008.196790.
Massard G, Rougé C, Dabbagh A, Kessler R, Hentz JG, Roeslin N, Wihlm JM, Morand G. Tracheobronchial lacerations after intubation and tracheostomy. The Annals of thoracic surgery. 1996 May:61(5):1483-7
Borasio P, Ardissone F, Chiampo G. Post-intubation tracheal rupture. A report on ten cases. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 1997 Jul:12(1):98-100
Grewal HS, Dangayach NS, Ahmad U, Ghosh S, Gildea T, Mehta AC. Treatment of Tracheobronchial Injuries: A Contemporary Review. Chest. 2019 Mar:155(3):595-604. doi: 10.1016/j.chest.2018.07.018.
Parekh K, Iannettoni MD. Complications of esophageal resection and reconstruction. Seminars in thoracic and cardiovascular surgery. 2007 Spring:19(1):79-88
Juvekar NM, Deshpande SS, Nadkarni A, Kanitkar S. Perioperative management of tracheobronchial injury following blunt trauma. Annals of cardiac anaesthesia. 2013 Apr-Jun:16(2):140-3. doi: 10.4103/0971-9784.109772.
Herrmann D, Volmerig J, Al-Turki A, Braun M, Herrmann A, Ewig S, Hecker E. Does less surgical trauma result in better outcome in management of iatrogenic tracheobronchial laceration? Journal of thoracic disease. 2019 Nov:11(11):4772-4781. doi: 10.21037/jtd.2019.10.22.
de Lesquen H, Avaro JP, Gust L, Ford RM, Beranger F, Natale C, Bonnet PM, D'Journo XB. Surgical management for the first 48 h following blunt chest trauma: state of the art (excluding vascular injuries). Interactive cardiovascular and thoracic surgery. 2015 Mar:20(3):399-408. doi: 10.1093/icvts/ivu397.
Jougon J, Ballester M, Choukroun E, Dubrez J, Reboul G, Velly JF. Conservative treatment for postintubation tracheobronchial rupture. The Annals of thoracic surgery. 2000 Jan:69(1):216-20
Gómez-Caro A, Ausín P, Moradiellos FJ, Díaz-Hellín V, Larrú E, Pérez JA, de Nicolás JL. Role of conservative medical management of tracheobronchial injuries. The Journal of trauma. 2006 Dec:61(6):1426-34; discussion 1434-5
Cardillo G, Carbone L, Carleo F, Batzella S, Jacono RD, Lucantoni G, Galluccio G. Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non-surgical treatment. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2010 Mar:37(3):581-7. doi: 10.1016/j.ejcts.2009.07.034.
Lee SK, Kim DH, Lee SK, Kim YD, Cho JS, I H. Does Surgical Repair Still have a Role for Iatrogenic Tracheobronchial Rupture? Clinical Analysis of a Thoracic Surgeon's Opinion. Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 2016 Dec 20:22(6):348-353. doi: 10.5761/atcs.oa.16-00189.
Madden BP. Evolutional trends in the management of tracheal and bronchial injuries. Journal of thoracic disease. 2017 Jan:9(1):E67-E70. doi: 10.21037/jtd.2017.01.43.
Prokakis C, Koletsis EN, Dedeilias P, Fligou F, Filos K, Dougenis D. Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. Journal of cardiothoracic surgery. 2014 Jun 30:9():117. doi: 10.1186/1749-8090-9-117.