Tracheobronchial Tear in Emergency Care: Rapid Recognition, Airway Stabilization, and Definitive Management Strategies

Background: Tracheobronchial tear is a rare but life-threatening airway injury resulting from blunt or penetrating trauma or iatrogenic interventions. Its diagnostic challenge and high mortality underscore the need for rapid recognition and effective management. Aim: To review the etiology, epidemiology, pathophysiology, diagnostic strategies, and management principles of tracheobronchial tears in emergency care settings. Methods: A comprehensive literature-based analysis was conducted, synthesizing evidence from trauma registries, postmortem studies, and clinical series. Mechanisms of injury, diagnostic modalities, and treatment approaches were examined to identify best practices for emergency and perioperative care. Results: Tracheobronchial injuries occur predominantly near the carina and main bronchi, with blunt trauma associated with higher mortality than penetrating injuries. Up to 70% of cases are initially missed, often presenting with nonspecific signs such as persistent pneumothorax and subcutaneous emphysema. Fiberoptic bronchoscopy remains the gold standard for diagnosis and airway stabilization. Definitive management typically involves surgical repair, although conservative and endoscopic strategies are viable for select iatrogenic injuries. Prognosis improves significantly with early recognition and multidisciplinary intervention. Conclusion: Early suspicion, bronchoscopy-guided airway control, and mechanism-sensitive management are critical to reducing morbidity and mortality. Structured trauma protocols and preventive measures for iatrogenic injury can further enhance outcomes.