%0 Journal Article
%T Perioperative and Intensive Care Management of Pediatric Tracheal Tear
%A Sanjay M. Bhananker
%A Ramesh Ramaiah
%J Case Reports in Medicine
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/738216
%X Management of tracheal tears can prove to be challenging in the perioperative setting. This is a rare condition that can be life threatening. Here, we present a case of seven-year-old boy involved in a high-speed motor vehicle collision. The child sustained multiple injuries including a near fatal head injury, multiple facial fractures, and a tracheal injury associated with pneumomediastinum. Due to the imminent threat of brainstem herniation while being imaged in the CT scanner, the patient underwent an emergent craniotomy to evacuate his evolving intracranial bleed. Imaging prior to the craniectomy suggested a possible tracheal injury, given the extensive pneumomediastinum. However, initial perioperative ventilation was without any difficulty. After stabilization of intracranial pressure (ICP) and hemodynamics, on hospital day 4, the patient returned to the operating room to diagnose and repair his tracheobronchial injury. This is a unique polytrauma case in which a tracheal tear was managed in the midst of other life-threatening injuries. 1. Introduction Tracheal bronchial injuries, whether iatrogenic or traumatic, can be challenging to manage perioperatively due to challenges in securing the airway, ventilation difficulty, and hemodynamic instability [1]. Traumatic tracheobronchial injuries may be underreported secondary to their association with high mortality prior to operative repair [2]. Furthermore, reports of spontaneous tracheal injury are even rarer [3]. In this report, we present this interesting case in which the mechanism of injury was likely to be consistent with a possible burst fracture type of phenomenon where increased intrathoracic pressure occurred against a closed glottis at the time of injury. 2. Case History The patient was a seven-year-old, 22£¿kg boy who was a backseat, restrained passenger involved in a high-speed motor vehicle collision. He sustained severe head trauma with a depressed frontal skull fracture and subdural hematoma. He was intubated in the field by the paramedics, with a 6.0 cuffed ET tube. He was taken emergently to the operating room for a decompressive craniectomy after he was noted to be unstable in the CT Scanner due to an imminent brainstem herniation. In the preoperative scans, there was evidence of air tracking from the right mediastinum up to the right common carotid artery, continuing up to the C2-C3 disk level. The patient underwent a bilateral frontal and right temporal craniectomy. A 6.0 cuffed ETT was in situ and secured at 15.5£¿cm at the level of the teeth. The patient was maintained on
%U http://www.hindawi.com/journals/crim/2014/738216/