E1428. Complicated Tracheal Injury After Endotracheal Intubation
Authors
Cheong Hwan Shin;
Wonkwang University Hospital, Wonkwang University College of Medicine
Se Ri Kang;
Wonkwang University Hospital, Wonkwang University College of Medicine
Ji Young Rho;
Wonkwang University Hospital, Wonkwang University College of Medicine
Hye Won Kim;
Wonkwang University Hospital, Wonkwang University College of Medicine
Background
Post-intubation tracheal injury is a rare and potentially fatal complication. Among the most common causes, cuff overinflation and repetitive attempts of orotracheal intubation in emergency situations are paramount. The most common clinical manifestations are subcutaneous emphysema in the chest and neck, as well as pneumomediastinum, and pneumothorax. In addition, complications of tracheal injuries include fistula formation with adjacent structures and mediastinitis. Diagnosis is confirmed by bronchoscopy, and the treatment can be either conservative or surgical. Awareness of imaging features of tracheal injuries following endotracheal intubation can suggest the diagnosis of tracheal injury and its complications, thus leading to early confirmatory bronchoscopy and definitive treatment.
Educational Goals / Teaching Points
To understand tracheal anatomy with regard to fragile site to injury and relation with properly-placed endotracheal tube. To be familiar with the radiologic features of tracheal injuries following endotracheal intubation.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomy of trachea and proper endotracheal intubation (normal anatomy and vulnerable point of trachea, imaging features in well-performed endotracheal intubation). Tracheal injuries following endotracheal intubation (risk factor and mechanisms, malpositioned endotracheal tube and overinflated cuff, imaging features - extrapulmonary air, mediastinitis, and fistula formation with adjacent structures). Management.
Conclusion
In summary, posterior wall (right side) of trachea is most vulnerable. Tip of endotracheal tube should be 5cm above the carina, and cuff can fill but not expand the tracheal wall. Malpositioned tube or overinflated cuff can induce tracheal injuries. Tracheal injuries after endotracheal intubation can present extrapulmonary air, mediastinitis and fistula formation between trachea and adjacent. In conclusion,
Radiologists should understand tracheal anatomy and be familiar with the radiologic features of tracheal injuries to prevent delayed diagnosis.
