Traumatic tracheal injury after motorcycle accident

Patient was intubated on site and ventilated with lung protective ventilation (tidal volume of 6 mL/kg), positive end-expiratory pressure of 5 and a fraction of inspired oxygen of 100%, which allowed him to maintain SpO2 levels of 97%–98% throughout the ambulance transfer. The true incidence of tracheal injuries (TIs) is unknown as 30%–80% of these trauma victims die at the scene of the accident.1 2 Currently, the incidence of TI among trauma patients with chest and neck injuries, including those who died immediately, is estimated at 0.5%–2%.2 3 The mortality from traumatic TIs has decreased from 36% before 1950 and 30% in 1966 to 9% in 2001,1 probably due to improvements in prehospital care and early initiation of the Advanced Trauma Life Support protocol.2 Surgical management of TIs can be achieved with acceptable mortality,4 and most TI can be repaired primarily using a specific surgical approach tailored to the patient’s injury. Associated injuries are common, and surgeons must be knowledgeable in treating a wide variety of anatomic abnormalities.5 This case brings us a clear example of what existing literature has already stated on this topic: regardless of the anatomic location or the mechanism of the injury, delay in diagnosis is the single most important factor influencing outcome.