Bronchoscopic Findings of Post-intubation Tracheal Rupture in Critically Ill Patients: Report of Four Cases and Review of the Literature

氣管破裂乃氣管插管罕見但可能致命的併發症。我們在此報告四例氣管插管後併發氣管破裂的支氣管鏡檢下的不同表現。其中一例之氣管破裂直接向氣管內管通條所致。四位病患皆為高齡女性（82±9歲）且病況嚴重（APACHEH Ⅱ分數35±5）。四位皆因呼吸衰竭而接受緊急氣管插管。四位皆無併發氣胸。皮下氣腫是最早的表徵，在插管後3.1±2.3小時被發現。我們發現有明顯的診斷延誤（5.3±2.0天），超長的加護病房住院天數（24±22,中數，15天）及總住院天數（46±34,中數，38天）。死亡率則高達50%。因此，我們對於插管前的步驟作一些建議以減少此一併發症的發生，並建議針對氣管插管後病人作完整的理學檢查以便及早發現皮下氣腫以利早期診斷氣管破裂。當氣管插管後發生皮下氣腫，應進一步安排胸腔電腦斷層掃描及支氣管鏡檢查。

關鍵字

氣管插管；氣管破裂；支氣管鏡檢查；皮下氣腫

並列摘要

Tracheal rupture is a rare but potentially life-threatening complication of endotracheal intubation. We present four cases of post-intubation tracheal rupture with various bronchoscopic findings. One of the ruptures was caused by a direct stylet injury. All of the patients were elderly women (82±8 years) with critical medical conditions (APACHE Ⅱ score 35±5) who underwent emergency intubation due to respiratory failure. None of them had pneumothorax. Subcutaneous emphysema was the earliest sign, noted at 3.1±2.3 hours after intubation. All patients experienced a delayed diagnosis (5.3±1.9 days), and lengthy ICU (24±22 days, median 15 days) and hospital (46±34 days, median 38 days) stays. The mortality rate was high (50%). We offer a suggestion on how to avoid this complication, and recommend a detailed physical examination for subcutaneous emphysema for every intubated patient in order to obtain an early diagnosis. Post-intubation subcutaneous emphysema should mandate a chest computed tomography and bronchoscopic evaluation for this potentially life-threatening condition.

並列關鍵字

endobronchial intubation ； tracheal rupture ； bronchoscopy ； subcutaneous emphysema

國際替代計量

Bronchoscopic Findings of Post-intubation Tracheal Rupture in Critically Ill Patients: Report of Four Cases and Review of the Literature

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