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Thoracotomy for emergency repair of iatrogenic tracheal rupture: single center analysis of perioperative management and outcomes.
- Source :
- BMC Anesthesiology; 10/27/2019, Vol. 19 Issue 1, pN.PAG-N.PAG, 1p
- Publication Year :
- 2019
-
Abstract
- Background: Iatrogenic tracheal ruptures are rare but life-threatening airway complications that often require surgical repair. Data on perioperative vital functions and anesthetic regimes are scarce. The goal of this study was to explore comorbidity, perioperative management, complications and outcomes of patients undergoing thoracotomy for surgical repair. Methods: We retrospectively evaluated adult patients who required right thoracotomy for emergency surgical repair of iatrogenic posterior tracheal ruptures and were admitted to a university hospital over a 15-year period (2004–2018). The analyses included demographic, diagnostic, management and outcome data on preinjury morbidity and perioperative complications. Results: Thirty-five patients who met the inclusion criteria were analyzed. All but two patients (96%) presented with critical underlying diseases and/or emergency tracheal intubations. The median time (interquartile range) from diagnosis to surgery was 0.3 (0.2–1.0) days. The durations of anesthesia, surgery and one-lung ventilation (OLV) were 172 (128–261) min, 100 (68–162) min, and 52 (40–99) min, respectively. The primary airway management approach to OLV was successful in only 12 patients (34%). Major complications during surgery were observed in 10 patients (29%). Four patients (11%) required cardiopulmonary resuscitation, one of whom received extracorporeal membrane oxygenation, and another one of these patients died during surgery. Major complications were associated with significantly higher all-cause 30-day mortality (p = 0.002) and adjusted mortality (p = 0.001) compared to patients with minor or no complications. Conclusions: Surgical repair of iatrogenic tracheal ruptures requires advanced perioperative care in a specialized center due to high morbidity and potential complications. Airway management should include early anticipation of alternative OLV approaches to provide acceptable conditions for surgery. [ABSTRACT FROM AUTHOR]
- Subjects :
- TRACHEA injuries
SURGICAL complication risk factors
MORTALITY risk factors
ACADEMIC medical centers
AIRWAY (Anatomy)
ANESTHESIA
ARTIFICIAL respiration
CARDIOPULMONARY resuscitation
DISEASES
EMERGENCY medical services
EXTRACORPOREAL membrane oxygenation
IATROGENIC diseases
RISK assessment
ORGAN rupture
TRACHEA intubation
COMORBIDITY
SOCIOECONOMIC factors
TREATMENT effectiveness
RETROSPECTIVE studies
TREATMENT duration
PERIOPERATIVE care
THORACOTOMY
Subjects
Details
- Language :
- English
- ISSN :
- 14712253
- Volume :
- 19
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- BMC Anesthesiology
- Publication Type :
- Academic Journal
- Accession number :
- 139324085
- Full Text :
- https://doi.org/10.1186/s12871-019-0869-5