Published online Jun 6, 2022. doi: 10.12998/wjcc.v10.i16.5185
Peer-review started: August 14, 2021
First decision: November 17, 2021
Revised: November 21, 2021
Accepted: April 2, 2022
Article in press: April 2, 2022
Published online: June 6, 2022
Processing time: 291 Days and 17.3 Hours
The number of patients with bronchial trauma (BT) who survived to the hospital has increased with the improvement of prehospital care; early diagnosis and treatment should be considered, especially among blunt trauma patients whose diagnosis is frequently delayed.
Treatment of the injury is not the difficult part, but timely diagnosis of bronchial injury does. In this paper, we try to analyze the characteristics of blunt and penetrating bronchial injuries and clarify the difference between them.
In this study, we reviewed and analyzed the data of blunt and penetrating bronchial injuries cases that we had dealt with to describe the early recognition and surgical management considerations of the two types of bronchial injuries.
Data from all patients with chest trauma treated at the Chongqing Emergency Medical Center from July 2005 to June 2020 were reviewed, and BT data were screened for retrospective analysis regarding sex, age, injury mechanism, diagnostic and therapeutic methods, and outcome. Patients were divided into two groups according to the injury mechanism: Blunt BT (BBT) and penetrating BT (PBT).
A total of 73 patients with BT were admitted during the study period. The proportion of BTs in the entire cohort of chest trauma was 2.4% (73/3018). All 73 underwent thoracotomy. Polytrauma patients accounted for 81.6% in the BBT group and 22.9% in the PBT group; the mean Injury Severity Score was 38.22 ± 8.13 and 21.33 ± 6.12, respectively. Preoperative three-dimensional spiral computed tomography (CT) and/or fiberoptic bronchoscopy (FB) were performed in 92.1% of cases in the BBT group (n = 38) and 34.3% in the PBT group (n = 35). In the BBT group, delayed diagnosis over 48 h occurred in 55.3% of cases. In the PBT group, 31 patients underwent emergency thoracotomy for massive hemothorax, and BT was confirmed during the operation. Among them, 22 underwent pulmo-tractotomy for hemostasis, avoiding partial pneumonectomy. In this series, the overall mortality rate was 6.9% (5/73), and it was 7.9% (3/38) in the BBT group and 5.7 % (2/35) in the PBT group (P > 0.05). All 68 survivors were followed for 6 to 42 (23 ± 6.4) mo, and CT, FB, and pulmonary function examinations were performed as planned. All patients exhibited normal lung function and healthy conditions except three who required reoperations.
The difference between blunt and penetrating BT is obvious. In BBT, patients generally have no vessel injury, and the diagnosis and treatment are easily delayed and missed. The main cause of death is ventilation disturbance due to tension pneumothorax early and refractory atelectasis with pneumonia late. However, in PBT, most patients require emergency thoracotomy because of simultaneous vessel trauma and massive hemothorax; a delayed diagnosis is infrequent. The leading cause of death is hemorrhagic shock.
Treatment of bronchial injuries should focus more on early diagnosis and timely management.