Patricio Rioseco S¹, Sergio Tapia Z¹, Verónica Céspedes S², Juan Pablo Silva C³, Paulina Lozano F³

Show more
¹ Respiratory Unit, Hospital Las Higueras, Talcahuano, Chile.
² Transfusional Medicine Unit, Hospital Las Higueras, Talcahuano, Chile.
³ Internal Medicine, Universidad de Concepciòn, Concepciòn, Chile.
Show less

Abstract: The use of PRP involves a complex network of molecular events which accelerate tissue regenera-tion due to its richness in growth factors plus a variety of biologic mediators. Several communica-tions tell us about its usefulness on the dental implantology field, plastic surgery, orthopedics and peripheral nerve regeneration after trauma. We have presented our successful experience of its use in pneumology when treating severe hemoptysis, respiratory fistulae, spontaneous pneumothorax and one tracheal rupture. In this article we present two cases of post intubation tracheal rupture successfully treated with the local instillation of PRP on one of them and with the injection of PRP along the lips of the tracheal wound on the other. Tracheal rupture is a rare but life threatening complication of emergency intubation requiring an effective response in order to avoid the risk of patient death due to secondary mediastinitis and sepsis. Up to now there is no general consensus in the treatment of this condition and alternatives in use are not universally accepted. The use of local autologous PRP in our experience has demonstrated a favorable performance in such cases, turning it in a highly promising tool for the treatment of conditions such as this, in which a rapidly effective and minimally invasive handling is required.

Keywords: Tracheal Rupture, Endotracheal Intubation, Platelet Rich Plasma

Cite this paper: Rioseco S, P. , Tapia Z, S. , Céspedes S, V. , Silva C, J. and Lozano F, P. (2015) Use of Platelet Rich Plasma (PRP) in the Treatment of Acute Post Intubation Tracheal Rupture: Report of Two Cases. International Journal of Clinical Medicine, 6, 487-495. doi: 10.4236/ijcm.2015.67065.

References

[1]   Whiteheart, S.W. (2011) Platelets Granules: Surprise Packages. Platelets and Thrombopoiesis. Blood, 118, 1190-1191.

[2]   Gunning, W. (2003) The Platelet Delta Granule and Its Role in Hemostasis. Microscopy and Microanalysis, 9, 1362-1363.

[3]   Ciferri, S., et al. (1998) Platelets Release Lambda-Granules (Lysosimes) in Vivo in Humans upon Activation. Thrombosis Research, 91, 36.

[4]   Lee, J.W., Kwon, O.H., Kim, T.K., Cho, Y.K., Choi, K.Y., Chung, H.Y., et al. (2013) Platelet Rich Plasma: Quantitative Assessment of Growth Factor Levels and Comparative Analysis of Activated an Inactivated Groups. Archives of Plastic Surgery, 40, 530-535.
http://dx.doi.org/10.5999/aps.2013.40.5.530

[5]   Chang, C.-Y., Cheng, S.-L. and Chang, S.-C. (2011) Conservative Treatment of Severe Tracheal Laceration after Endotracheal Intubation. Respiratory Care, 56, 861-862.
http://dx.doi.org/10.4187/respcare.00891

[6]   Chen, E.H., Logman, Z.M., Glass, P.S.A. and Bilfinger, T.V. (2001) A Case of Tracheal Injury after Emergency Endotracheal Intubation: A Review of the Literature and Causalities. Anesthesia & Analgesia, 93, 1270-1271.
http://dx.doi.org/10.1097/00000539-200111000-00047

[7]   Ramos Izquierdo, R., Moya Amoròs, J., Morera Abad, R., Pujol Rovira, R., Perna, V. and Ferrer Recuero, G. (2006) Iatrogenic Tracheal Ruptura after Endotracheal Intubation. Cirugía Española, 80, 46-48.
http://dx.doi.org/10.1016/S0009-739X(06)70916-2

[8]   Massard, G., Rougè, C., Dabbagh, A., Kessler, R., Hentz, J.G., Roeslin, N., Wihlm, J.M. and Morand, G. (1996) Tracheobronchial Lacerations after Intubation and Tracheostomy. Annals of Thoracic Surgery, 61, 1483-1487.
http://dx.doi.org/10.1016/0003-4975(96)00083-5

[9]   Cardillo, G., Carbone, L., Carleo, F., Batzella, S., Jacono, R.D., Lucantoni, G. and Galluccio, G. (2010) Tracheal Lacerations after Endotracheal Intubation: A Proposed Morphological Classification to Guide Non-Surgical Treatment. European Journal of Cardio-Thoracic Surgery, 37, 581-587.
http://dx.doi.org/10.1016/j.ejcts.2009.07.034

[10]   Ovari, A., Justi, T., Dommerich, S., Hingst, V., Bôttcher, A., Schuldt, T., Guder, E., Mencke, T. and Pau, H.W. (2014) Conservative Management of Post Intubation Tracheal Tears—Report of Three Cases. Journal of Thoracic Disease, 6, E85-E91.

[11]   Dettmeyer, R.B., Schütz, H.F. and Verhoff, M.A. (2013) Forensic Medicine: Fundamentals and Perspectives. Berlin, Heidelberg.

[12]   Tewfick, T.L. and Gest, T.R. (2013) Trachea Anatomy. Medscape.

[13]   Hayi-Slayman, D., Page, M., Ben Cheikh, A., Christin, F., Ber, C.E. and Rimmelè, T. (2007) Tracheal Rupture after Orotracheal Intubation in Intensive Care. Annales Françaises d’Anesthésie et de Réanimation, 26, 600-603.

[14]   Chen, J.D., Shanmuganathan, K., Mirvis, S.E., Killeen, K.L. and Dutton, R.P. (2001) Using CT to diagnose tracheal rupture. American Journal of Roentgenology, 176, 1273-1280.
http://dx.doi.org/10.2214/ajr.176.5.1761273

[15]   Faure, A., Floccard, B., Pilleul, F., Faure, F., Badinand, B., Mennesson, N., Ould, T., Guillaume, C., Levrat, A., Benatir, F. and Allaouchiche, B. (2007) Multiplanar Reconstruction: A New Method for the Diagnosis of Tracheobronchial Rupture? Intensive Care Medicine, 33, 2173-2178.

[16]   Miñambres, E., Buron, J., Ballesteros, M.A., Llorca, J., Muñoz, P. and Gonzalez-Castro, A. (2009) Tracheal Rupture after Endotracheal Intubation: A Literature Systematic Review. European Journal of Cardio-Thoracic Surgery, 35, 1056-1062.
http://dx.doi.org/10.1016/j.ejcts.2009.01.053

[17]   Park, I.K., Lee, J.G., Lee, C.Y., Kim, D.J. and Chung, K.Y. (2007) Transcervical Intraluminal Repair of Posterior Membranous Tracheal Laceration through Semi-Lateral Transverse Tracheotomy. The Journal of Thoracic and Cardiovascular Surgery, 134, 1597-1598.
http://dx.doi.org/10.1016/j.jtcvs.2007.09.001

[18]   Ambrogi, M.C., Mussi, A., Ribechini, A. and Angeletti, C.A. (2001) Posterior Wall Laceration of the Thoracic Trachea: The Transcervical-Transtracheal Approach. European Journal of Cardio-Thoracic Surgery, 19, 932-934.
http://dx.doi.org/10.1016/S1010-7940(01)00678-9

[19]   Lyons, J.D., Feliciano, D.V., Wyrzykowski, A.D. and Rozycki, G.S. (2013) Modern Management of Penetrating Tracheal Injuries. American Surgeon, 79, 188-193.

[20]   Nazari, S., Buniva, P., Aluffi, A., Salvi, S. and Mourad, Z. (1999) Decompressing Tracheostomy for the Treatment of Post Intubation Tracheal Rupture. The Annals of Thoracic Surgery, 68, 1122-1125.

[21]   Creagh-Brown, B., Sheth, A., Crerar-Gilbert, A. and Madden, B.P. (2008) A Novel Approach to the Management of Acute Tracheal Tear. The Journal of Laryngology Otology, 122, 1392-1393.

[22]   Welter, S., Krbek, T., Halder, R. and Stamatis, G. (2011) A New Technique for Complete Intraluminal Repair of Iatrogenic Posterior Tracheal Lacerations. Interactive Cardiovascular and Thoracic Surgery, 12, 6-9.
http://dx.doi.org/10.1510/icvts.2010.248641

[23]   Steindor, M., Schuster, A., Hoehn, T., Mayatepek, E., Santos, M., Angenendt, S., Klee, D. and Schramm, D. (2014) Conservative Treatment of Tracheal Injuries. Journal of Pediatric Surgery Case Reports, 2, 294-296.

[24]   Wilson, S.M., Pell, P. and Donegan, E.A. (1991) HIV-1 Transmission Following the Use of Cryoprecipitate Fibrinogen as Gel/Adhesive. Transfusion, 31, 51S.

[25]   Hino, M., Ishiko, O., Hinda, K.I., Yamane, T., Ohta, K., Takubo, T. and Tatsumi, N. (2000) Transmission of Symptomatic Parvovirus B19 Infection by a Fibrin Sealant Used during Surgery. British Journal of Haematology, 108, 195-195.
http://dx.doi.org/10.1046/j.1365-2141.2000.01818.x

[26]   Milde, L.M. (1989) An Anaphylactic Reaction to Fibrin Glue. Anesthesia & Analgesia, 69, 684-686.
http://dx.doi.org/10.1213/00000539-198911000-00026

[27]   Gomez-Caro, A., Ausin, P. and Boada, M. (2012) Platelet Rich Plasma Improves the Healing Process after Airway Anastomosis. Interactive Cardiovascular and Thoracic Surgery, 13, 552-556.
http://dx.doi.org/10.1510/icvts.2011.273995

[28]   Spartalis, E., Tomos, P., Konofaos, P., Karagkiouzis, G., Levidou, G., Kavantzas, N., Pantopoulou, A., Michail, O., Perrea, D. and Kouraklis, G. (2013) The Effect of Autologous Platelet-Rich Plasma on Bronchial Stump Tissue Granulation after Pneumonectomy: Experimental Study. International Scholarly Research Notices Surgery, 2013, Article ID: 864350.

[29]   Rioseco, P., Cespedes, V., Muñoz, S., Tapia, S. and Vasquez, D. (2014) Utilidad del plasma rico en plaquetas en neumología. Revista chilena de enfermedades respiratorias, 30, 156-165.
http://dx.doi.org/10.4067/S0717-73482014000300005