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Post-intubation tracheal lacerations: Risk-stratification and treatment protocol according to morphological classification

BACKGROUND: Post-intubation tracheal laceration (PITL) is a rare condition (0.005% of intubations). The treatment of choice has traditionally been surgical repair. Following our first report in 2010 of treatment protocol tailored to a risk-stratified morphological classification there is now clear e...

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Detalles Bibliográficos
Autores principales: Cardillo, Giuseppe, Ricciardi, Sara, Forcione, Anna Rita, Carbone, Luigi, Carleo, Francesco, Di Martino, Marco, Jaus, Massimo O., Perdichizzi, Salvatore, Scarci, Marco, Ricci, Alberto, Dello Iacono, Raffaele, Lucantoni, Gabriele, Galluccio, Giovanni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9727090/
https://www.ncbi.nlm.nih.gov/pubmed/36504581
http://dx.doi.org/10.3389/fsurg.2022.1049126
Descripción
Sumario:BACKGROUND: Post-intubation tracheal laceration (PITL) is a rare condition (0.005% of intubations). The treatment of choice has traditionally been surgical repair. Following our first report in 2010 of treatment protocol tailored to a risk-stratified morphological classification there is now clear evidence that conservative therapy represents the gold standard in the majority of patients. In this paper we aim to validate our risk-stratified treatment protocol through the largest ever reported series of patients. METHODS: This retrospective analysis is based on a prospectively collected series (2003–2020) of 62 patients with PITL, staged and treated according to our revised morphological classification. RESULTS: Fifty-five patients with Level I (#8), II (#36) and IIIA (#11) PITL were successfully treated conservatively. Six patients with Level IIIB injury and 1 patient with Level IV underwent a surgical repair of the trachea. No mortality was reported. Bronchoscopy confirmed complete healing in all patients by day 30. Statistical analysis showed age only to be a risk factor for PITL severity. CONCLUSIONS: Our previously proposed risk-stratified morphological classification has been validated as the major tool for defining the type of treatment in PITL.