AAST Grading of Tracheal Injury
I cannot provide the AAST grading system for tracheal injury because the evidence provided does not contain the AAST tracheal injury classification scale. The available evidence only includes the AAST liver trauma classification 1, which is not applicable to tracheal injuries.
What the Evidence Does Provide
Management Approach for Tracheal Injuries
While the AAST grading system is not available in the evidence, I can outline the management principles for tracheal injuries based on the available literature:
Conservative Management is Preferred for Most Iatrogenic Tracheal Injuries
Non-surgical treatment should be the initial approach for most post-intubation tracheal lacerations (PITLs), with surgery reserved only for injuries involving esophageal damage or mediastinitis 2.
Morphological Classification for Treatment Decisions
A proposed classification system for PITLs guides non-surgical treatment 2:
Level I injuries (mucosal/submucosal involvement without mediastinal emphysema): Managed conservatively with 100% success 2
Level II injuries (tracheal lesion to muscular wall with subcutaneous/mediastinal emphysema, no esophageal injury): Successfully treated non-surgically in all cases 2
Level IIIA injuries (complete tracheal wall laceration with herniation but no esophageal injury): Can be managed conservatively in selected institutions with adequate respiratory status 2
Level IIIB injuries (any laceration with esophageal injury or mediastinitis): Requires immediate surgical repair 2
Pediatric Considerations
Conservative management is particularly effective in children with non-penetrating tracheobronchial injuries, avoiding open surgical procedures in the majority of cases 3. All eight pediatric patients in one series healed spontaneously without initial open surgery, though 62.5% developed some degree of tracheal stenosis requiring monitoring 3.
Emergency Airway Management
Airway control and appropriate ventilation represent the key aspects of emergency management for tracheal trauma 4. Endotracheal intubation or alternative airway management should be performed without delay in the presence of airway obstruction, altered consciousness (GCS ≤8), hypoventilation, or hypoxemia 1.
Diagnostic Approach
Laryngoscopy, flexible and/or rigid bronchoscopy, and computed tomography of the chest are the procedures of choice for definitive diagnosis 4. Early diagnostic evaluation is critical for successful treatment 5.
Critical Gap in Evidence
To properly answer your question about AAST grading of tracheal injury, you would need access to the official AAST Organ Injury Scale for tracheal/tracheobronchial injuries, which typically grades injuries from I to V based on anatomical severity. This classification system is not present in the provided evidence.