Intra- and postoperative airway management of tracheal carina ruptures from bilateral endobronchial intubation

Carina near tracheal ruptures following blunt chest trauma or endotracheal intubation are rare, but lifethreatening events. Both early diagnosis by fibreoptic bronchoscopy and immediate surgical treatment are essential. There is no uniform recommendation for airway-management concerning the tube. Standard tracheal- and double-lumen tubes position the cuff at the site of the injury and tracheostomy tubes are too short to protect the lesion from positive airway pressure. We discuss the causes, diagnosis, and treatment of tracheal ruptures, reviewing the recent literature. We analysed data from three female patients who sustained carina near tracheal ruptures. They underwent selective endobronchial intubation with two tubes, both under fibreoptic control. Following the surgical repair the tubes were then introduced via tracheostomy. Because of severe respiratory failure (aspiration pneumonia, mediastinitis, status asthmaicus, ARDS) independent lung ventilation was performed for 9-14 days. Obviously the fixation of the tubes is most essential and their correct position was confirmed by daily fibreoptic or radiologic control. Then a single tracheostomy tube was inserted. The patients respiratory functions improved and they were discharged from ICU after 21-36 days, breathing spontaneously with closed tracheostoma. No long-term complications were noted. Maintaining the safety procedures the bilateral endobronchial intubation is an important and successful method in carina near tracheal rupture, perioperatively and for long-term ventilation.