Table 1.
Demography, clinical presentation, perioperative care, and outcomes of patients with iatrogenic tracheal rupture
| Total (n = 35) | No and minor complications (n = 25) | Major complications (n = 10) | P | |
|---|---|---|---|---|
| Age, years | 67 (55–76) | 61 (53–73) | 75 (58–82) | 0.125 |
| Female | 25 (71) | 18 (72) | 7 (70) | 0.100 |
| BMI Clinical presentation | 26 (24–31) | 27 (27–32) | 24 (21–29) | 0.213 |
| ASA | 4 (3–4) | 4.0 (3–4) | 4.0 (3.75–5) | 0.313 |
| ICU before rupture | 19 (54.3) | 14 (56) | 5 (50) | 0.100 |
| CPR before rupture | 7 (20) | 5 (20) | 2 (20) | 0.100 |
| SAPS II | 52 (36–58) | 49 (33–58) | 56 (49–67) | 0.339 |
| SOFA | 7 (4–9) | 7 (4–9) | 6 (5–9) | 0.567 |
| Tear length, cm | 5 (4–6) | 5 (4–6) | 4 (4–6) | 0.737 |
| Causative events | 0.438 | |||
| Tracheal intubation | 20 (57) | 15 (60) | 5 (50) | |
| Emergency intubation | 18 (51) | 13 (52) | 5 (50) | |
| Tracheotomy | 9 (26) | 7 (28) | 2 (20) | |
| Surgery | 6 (17) | 3 (12) | 3 (30) | |
| Interfacility EMS referral | 17 (49) | 11 (44) | 6 (60) | 0.392 |
| Process times | ||||
| Rupture to surgery, days | 0.3 (0.2–1.0) | 0.3 (0.2–0.8) | 0.7 (0.2–3.4) | 0.272 |
| Anesthesia, minutes | 172 (128–261) | 160 (125–209) | 243 (149–304) | 0.093 |
| Surgery, minutes | 100 (68–162) | 97 (64–121) | 141 (78–222) | 0.265 |
| OLV, minutes | 52 (40–99) | 55 (40–91) | 63 (46–109) | 0.401 |
| Anesthesia management | ||||
| TIVA | 16 (45.7) | 12 (48) | 4 (40) | 0.723 |
| Tube advancement | 27 (77) | 18 (72) | 9 (90) | 0.390 |
| DLT | 11 (31) | 4 (4.9) | 0 (0.0) | 0.120 |
| Bronchus blocker | 3 (9) | 1 (4) | 2 (20) | 0.190 |
| Devices during surgery | 1 (0–2) | 1 (0–2) | 2 (0–2) | 0.388 |
| Tracheotomy | ||||
| Before surgery | 7 (20) | 4 (16) | 3 (30) | 0.761 |
| During surgery | 6 (17) | 5 (20) | 1 (10) | |
| After surgery | 7 (20) | 5 (20) | 2 (20) | |
| Not performed | 15 (43) | 11 (44) | 4 (40) | |
| Respiratory variables | ||||
| FiO2 1.0, % | 90 (75–100) | 90 (55–100) | 95 (80–100) | 0.547 |
| FiO2 other | 0.62 (0.5–0.8) | 0.6 (0.5–0.75) | 0.65 (0.45–0.8) | 0.961 |
| p/f ratio before | 141 (110–219) | 133 (115–212) | 157 (101–315) | 0.860 |
| p/f after | 143 (111–153) | 144 (133–154) | 97 (80–236) | 0.042 |
| SaO2 lowest, % | 76 (54–85) | 84 (65–88) | 54 (24–72) | 0.002 |
| etCO2 highest, mmHg | 46 (41–59) | 45 (40–59) | 51 (42–60) | 0.410 |
| PIP highest, mmHg | 25 (25–28) | 25 (25–29) | 25 (25–28) | 0.621 |
| PEEP highest, mmHg | 10 (8–12) | 10 (8–11) | 10 (8–12) | 0.509 |
| Circulation | ||||
| SBP lowest, mmHg | 74 (52–82) | 80 (70–86) | 40 (0–72) | < 0.001 |
| Noradrenaline, μg kg min−1 | 0.18 (0.1–0.31) | 0.10 (0.06–0.22) | 0.22 (0.2–0.84) | a |
| Adrenaline | 8 (22.9) | 1 (4) | 7 (70) | a |
| Dobutamine | 9 (25.7) | 5 (20) | 4 (40) | 0.398 |
| Crystalloid, L | 2 (1–2.5) | 1.5 (1–2) | 2.5 (1–4) | 0.009 |
| Transfusion | 14 (40) | 8 (32) | 6 (60) | 0.151 |
| Blood loss, ml | 450 (250–750) | 350 (250–575) | 725 (312–1150) | 0.107 |
| Lactate before, mmol/l | 1.3 (0.8–2.6) | 1.4 (1–2.6) | 1.1 (0.7–2.4) | 0.604 |
| Lactate after, mmol/l | 1.4 (1.1–3.1) | 1.3 (0.9–2.9) | 2.8 (1.5–5.6) | 0.083 |
| Urinary output, ml | 50 (0–100) | 50 (0–100) | 25 (0–162) | 0.734 |
| Outcome | ||||
| Ventilator days | 9 (4–18) | 10 (4–25) | 8 (3–14) | 0.494 |
| LOS ICU, days | 10 (6–24) | 11 (6–33) | 9 (5–14) | 0.118 |
| All-cause 30-day mortality | 16 (46) | 7 (28) | 9 (90) | 0.002 |
| Adjusted mortality | 7 (20) | 1 (4) | 6 (60) | 0.001 |
Data are medians (IQR) and counts (%); a, comparisons not applicable due to categorization; BMI body mass index, ASA American Society of Anesthesiologists classification, ICU intensive care unit, CPR cardiopulmonary resuscitation, SAPS II simplified acute physiology score revision two, SOFA sequential organ failure assessment, EMS emergency medical service, OLV one-lung ventilation, DLT double lumen tube, p/f paO2/FiO2-ratio, PIP peak inspiratory pressure, PEEP positive end-expiratory pressure, LOS length of stay. P values below 0.05 are significant