Tracheal and Pulmonary Injury

Chest injuries, both blunt and penetrating, are common and are responsible for at least a quarter of the mortalities seen in trauma patients. These injuries are diverse, encompassing the entirety of the respiratory tract from the trachea to the lungs. Tracheobronchial injuries most often lead to airway compromise and necessitate emergent surgical intervention to restore airway continuity. Although rare, tracheobronchial injuries are often fatal and even when timely managed are not uncommonly associated with anastomotic complications. The much more common pulmonary injuries include pneumothorax, hemothorax, and parenchymal injury. Although often managed nonoperatively, patients with pulmonary injuries may require surgical interventions to excise unsalvageable lung tissue, restore hemodynamic stability in cases of massive hemothorax, or evacuate retained blood clots. This chapter provides an overview of the common presentation and necessary diagnostic procedures for an accurate assessment of patients with tracheal and pulmonary injury. Furthermore, it describes the appropriate management for such patients and the complications that may arise.