The Great Role of Ventilator Parameters in Diagnosis of Right Main Bronchus Rupture Due to Blunt Chest Trauma

Abstract

Bronchial rupture following major blunt chest trauma should be suspected in any case of massive and persistentair leak through the intercostal drain tube. Chest radiographs and chest computed tomography scans (CT scans)are highly suggestive of this extremely rare tracheobronchial injury. The present study reported a patient whowas a 15-year-old boy. He was a case of a motor-car accident and was brought to the emergency room (ER)of Rajaie Hospital ( Shiraz, Iran) due to dyspnea and chest pain. The physical examination revealed a fewcrash injuries on his upper extremities, as well as subcutaneous emphysema in his neck. The chest X-rayrevealed a right clavicular fracture, multiple rib fractures, a right pneumothorax (but no complete collapseor fallen lung), and also pneumo-mediastinum and subcutaneous emphysema. The chest CT revealed severepulmonary contusion, severe right-sided pneumothorax, significant pneumo-mediastinum, subcutaneousemphysema, multiple right-side rib fractures, and mild displacement of the right main bronchus. Furthermore,no definitive signs of bronchial rupture were detected. Using a mechanical ventilator, the following parameterswere revealed. The maximum pressure (Pmax)=7cm, H2o (was very low), plateau pressure (P. Plateau), andexpiratory tidal volume (TV) were not detected due to insufficient amounts. Additionally, increasing TV didnot change those values. Bronchial rupture is one of the most important and serious differential diagnoses inforceful chest traumas when the mechanical ventilator reveals low Pmax, very low P.platue, and expiratory TV,with no change in those values with increasing TV.

Keywords

• tracheobronchial ruptures
• motor-car accident
• ct scan
• trauma
• mechanical ventilation