Use of a modified tracheal tube in a child with traumatic bronchial rupture:A case report and review of literature

BACKGROUND Trauma is one of the leading causes of death in the pediatric population.Bronchial rupture is rare,but there are potentially severe complications.Establishing and maintaining a patent airway is the key issue in patients with bronchial rupture.Here we describe an innovative method for maintaining a patent airway.CASE SUMMARY A 3-year-old boy fell from the seventh floor.Oxygenation worsened rapidly with pulse oxygen saturation decreasing below 60%,as his heart rate dropped.Persistent pneumothorax was observed with insertion of the chest tube.Fiberoptic bronchoscopy was performed,which confirmed the diagnosis of bronchial rupture.A modified tracheal tube was inserted under the guidance of a fiberoptic bronchoscope.Pulse oxygen saturation improved from 60%to 90%.Twelve days after admission,right upper lobectomy was performed using bronchial stump suture by video-assisted thoracic surgery without complications.A follow-up chest radiograph showed good recovery.The child was discharged from hospital three months after admission.CONCLUSION A modified tracheal tube could be selected to ensure a patent airway and adequate ventilation in patients with bronchial rupture.

Diagnosis and treatment of bronchial rupture from blunt thoracic trauma

Objective To evaluate the diagnosis and management of bronchial rupture from blunt thoracic trauma. Methods A group of 31 patients with bronchial rupture was involved. Chest roentgenography, tornography and bronchoscopy were performed on all patients. The surgical technique and complications were described.Results Diagnosis was confirmed by tomography and bronchoscopy in all the patients. End to end anastomosis was used in 26 patients. Four patients were operated with total pneurnonectomy. One patient was repaired with an intercostal muscle and rib flap with blood supply. Of the 31 patients, one died of adult respiratory distress syndrome after operation. Most patients had excellent surgical outcomes. 81％ (25/31)of the bronchial rupture were delayed in diagnosis and treatment. The classic symptoms and signs of bronchial rupture included subcutaneous emphysema, dyspnea and an intermediate coma interval. The roentgenogram showed mediastinal emphysema, pneumothorax, “drop lung” sign and marked radiodensity of hilum widened mediastinum.Conclusion Bronchoscopy is a useful and accurate method to diagnose and treat the bronchial rupture, with which surgeons can easily locate the rupture site during surgery. Surgical treatment could restore pulmonary function in most patients.

Emergency Treatment and Nursing Care of a Patient with Multiple Injuries and Right Main Bronchus Rupture

Objective: To investigate the rescue and nursing process of a trauma patient with multiple injuries and rupture of the right main bronchus. Methods: A patient with multiple injuries and rupture of the right main bronchus admitted to the emergency department of the Shenzhen Hospital of the University of Hong Kong was selected as the research object on December 11, 2019. Results: In this case, the medical team treated the patient under the guidance of ATLS (Advanced Traumatic Life Support), and for the first time in our department, we used bronchoscopy to replace the double-lumen endotracheal tube for left lung single-lung ventilation, finally the patient was successfully treated. Conclusion: Through a literature search, it is found that the main bronchus rupture is less common in clinical practice. In the trauma group, the use of fiberoptic bronchoscopy and the replacement of a double-lumen tracheal tube for left lung single-lung ventilation can improve the treatment rate of such patients and is worthy of clinical application.