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Pereira CS, Ferros C, Dinis I, Pereira D, Miguel D, Vico M. Clavipectoral fascial plane block for clavicle fracture surgery: a case report. J Perioper Pract 2024:17504589241264408. [PMID: 39056524 DOI: 10.1177/17504589241264408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Regional anaesthesia can be an attractive alternative anaesthetic approach in clavicle surgery, but it requires the peripheral block of multiple cervical and brachial nerves that transmit nociceptive information. Deep cervical plexus blocks, as paravertebral nerve block, can lead to severe side effects, such as unilateral diaphragmatic paralysis. CASE REPORT A 66-year-old male patient, American Society of Anesthesiologists physical status III, was scheduled for open reduction and internal fixation of the right clavicle with plates and screws after a high-energy trauma. Pre-anaesthetic evaluation revealed right hemopneumothorax and bilateral rib fractures. We decided to perform regional anaesthesia (superficial cervical plexus block and clavipectoral fascial plane block), combined with dexmedetomidine perfusion to avoid invasive mechanical ventilation and prevent additional pulmonary complications. The surgical procedure was successfully completed without any further anaesthesia requirements. The patient remained comfortable during the postoperative period. CONCLUSION Regional anaesthesia for clavicle surgeries has the advantage of promoting non-opioid free anaesthesia. Effective pain control enhances patient satisfaction and reduces the length of stay in hospital. In our case report, a combined superficial cervical plexus block and clavipectoral fascial plane block was a safe and effective regional anaesthetic approach.
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Affiliation(s)
- Cândida Sofia Pereira
- Anesthesiology Department, Centro Hospitalar de Tondela - Viseu, E.P.E., Viseu, Portugal
| | - Catarina Ferros
- Anesthesiology Department, Centro Hospitalar de Tondela - Viseu, E.P.E., Viseu, Portugal
| | - Inês Dinis
- Anesthesiology Department, Centro Hospitalar de Tondela - Viseu, E.P.E., Viseu, Portugal
| | - Dulce Pereira
- Anesthesiology Department, Centro Hospitalar de Tondela - Viseu, E.P.E., Viseu, Portugal
| | - Diogo Miguel
- Anesthesiology Department, Centro Hospitalar de Tondela - Viseu, E.P.E., Viseu, Portugal
| | - Manuel Vico
- Anesthesiology Department, Centro Hospitalar de Tondela - Viseu, E.P.E., Viseu, Portugal
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Freeman KA, Pipkin M, Machuca TN, Jeng E, Oduntan O, Moore FA, Peng YG, Philip J, Machado D, Beaver TM. Post-Traumatic Pneumonectomy and Management of Severely Contaminated Pleural Space. JTCVS Tech 2022; 13:275-279. [PMID: 35711215 PMCID: PMC9196252 DOI: 10.1016/j.xjtc.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
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Michelitsch C, Acklin YP, Hässig G, Sommer C, Furrer M. Operative Stabilization of Chest Wall Trauma: Single-Center Report of Initial Management and Long-Term Outcome. World J Surg 2019; 42:3918-3926. [PMID: 29959488 DOI: 10.1007/s00268-018-4721-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Conservative treatment of even severe thoracic trauma including flail chest was traditionally the standard of care. Recently, we reported possible benefits of surgical chest wall stabilization in accordance with other groups. The aim of this study was to critically review our indications and results of internal fixation of rib fractures in the long-term course. METHODS We retrospectively analyzed the data of a consecutive series of patients with internal rib fracture fixation at our institution from 8/2009 until 12/2014, and we retrospectively studied the late outcome through clinical examination or personal interview. RESULTS From 1398 patients, 235 sustained a severe thoracic trauma (AIS ≥3). In 23 of these patients, 88 internal rib fixations were performed using the MatrixRIB® system. The median age of these operated patients was 56 years [interquartile range (IQR) 49-63] with a median ISS of 21 [IQR 16-29]. From 18 local resident patients, follow-up was obtained after an average time period of 27.6 (12-68) months. Most of these patients were free of pain and had no limitations in their daily routine. Out of all implants, 5 splint tips perforated the ribs in the postoperative course, but all patients remained clinically asymptomatic. Plate osteosynthesis showed no loss of reduction in the postoperative course. No cases of hardware prominence, wound infection or non-union occurred. CONCLUSIONS In our carefully selected thoracic trauma patients, locked plate rib fixation seemed to be safe and beneficial not only in the early posttraumatic course, but also after months and years, patients remain asymptomatic and complete recovery as a rule. Trial registration number KEK BASEC Nr. 2016-01679.
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Affiliation(s)
- Christian Michelitsch
- Division of Thoracic Surgery, Department of Surgery, Cantonal Hospital, Loëstrasse 170, 7000, Graubünden, Switzerland.
| | - Yves Pascal Acklin
- Division of Trauma Surgery, Department of Surgery, Cantonal Hospital, Graubünden, Switzerland
| | - Gabriela Hässig
- Division of Thoracic Surgery, Department of Surgery, Cantonal Hospital, Loëstrasse 170, 7000, Graubünden, Switzerland
| | - Christoph Sommer
- Division of Trauma Surgery, Department of Surgery, Cantonal Hospital, Graubünden, Switzerland
| | - Markus Furrer
- Division of Thoracic Surgery, Department of Surgery, Cantonal Hospital, Loëstrasse 170, 7000, Graubünden, Switzerland
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Huang X, Magnotti LJ, Fabian TC, Croce MA, Sharpe JP. Does lack of thoracic trauma attenuate the severity of pulmonary failure? An 8-year analysis of critically injured patients. Eur J Trauma Emerg Surg 2019; 46:3-9. [PMID: 30712060 PMCID: PMC7223815 DOI: 10.1007/s00068-019-01081-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/30/2019] [Indexed: 11/03/2022]
Abstract
PURPOSE Patients with thoracic trauma are presumed to be at higher risk for pulmonary dysfunction, but adult respiratory distress syndrome (ARDS) may develop in any patient, regardless of associated chest injury. This study evaluated the impact of thoracic trauma and pulmonary failure on outcomes in trauma patients admitted to the intensive-care unit (ICU). METHODS All trauma patients admitted to the ICU over an 8-year period were identified. Patients that died within 48 h of arrival were excluded. Patients were stratified by baseline characteristics, injury severity, development of ARDS, and infectious complications. Multiple logistic regression was used to determine variables significantly associated with the development of ARDS. RESULTS 10,362 patients were identified. After exclusions, 4898 (50%) patients had chest injury and 4975 (50%) did not. 200 (2%) patients developed ARDS (3.6% of patients with chest injury and 0.5% of patients without chest injury). Patients with ARDS were more likely to have chest injury than those without ARDS (87% vs 49%, p < 0.001). However, of the patients without chest injury, the development of ARDS still led to a significant increase in mortality compared to those patients without ARDS (58% vs 5%, p < 0.001). Multiple logistic regression found ventilator-associated pneumonia (VAP) to be the only independent predictor for the development of ARDS in ICU patients without chest injury. CONCLUSIONS ARDS development was more common in patients with thoracic trauma. Nevertheless, the development of ARDS in patients without chest injury was associated with a tenfold higher risk of death. The presence of VAP was found to be the only potentially preventable and treatable risk factor for the development of ARDS in ICU patients without chest injury.
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Affiliation(s)
- Xin Huang
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave. #225, Memphis, TN, 38163, USA
| | - Louis J Magnotti
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave. #225, Memphis, TN, 38163, USA
| | - Timothy C Fabian
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave. #225, Memphis, TN, 38163, USA
| | - Martin A Croce
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave. #225, Memphis, TN, 38163, USA
| | - John P Sharpe
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave. #225, Memphis, TN, 38163, USA.
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5
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Abstract
Lung contusion resulting from chest trauma may be present various clinical pictures. It quite often remains unrecognized and is only suspected later when severe complications have developed. Lung contusion may present in association with chest trauma but may also occur alone. It has to be emphasized, that lung contusion as a clinical identity does not necessarily require a blunt or penetrating chest to be in the background. Nowadays, as a result of traffic accidents, following high energy deceleration, lung contusion may present without an actual tissue damage in the chest wall as a condition initiating an independent, life-threatening generalised process. Although lung contusion shows similarities to blast injury of the lung with respect to clinical consequences, other factors play a role in its aetiology and pathology. Its description and recognition as an independent pathology is not simple. Several approaches exist: thoracic trauma, pulmonary contusion, pulmonary laceration, lung contusion; although these may show similar clinical signs, manifest in different pathologies. Pathologies with similar meaning and possibly similar clinical course cannot, actually, be differentiated; they may accompany other injuries to the trunk, skull or extremities, which, alone, are associated with high morbidity and mortality. Generally, it can be declared that besides high energy, blunt injuries affecting the trunk, lung contusion, has been an often neglected additional radiological finding attached to the main report, despite the fact, that its late consequences crucially determine the prospects of the injured.
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Affiliation(s)
- Szilárd Rendeki
- Department of Anaesthesiology and Intensive Therapy, University of Pécs Medical School, Pécs, Hungary.,Department of Operational Medicine, Faculty of Medicine, University of Pécs, Medical School University of Pécs, Pécs, Hungary.,Medical Simulation Centre, University of Pécs MediSkillsLab, Pécs, Hungary
| | - Tamás F Molnár
- Department of Operational Medicine, Faculty of Medicine, University of Pécs, Medical School University of Pécs, Pécs, Hungary.,St. Sebastian Thoracic Surgery Unit, Petz Aladár Teaching Hospital, Győr, Hungary
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Abstract
Purpose of Review This article reviews the new definitions of pneumonia, discusses risk factors for pneumonia among trauma patients, presents the latest evidence for prevention strategies, discusses the best ways to make the diagnosis, and reviews the microbiology and treatment for trauma patients with pneumonia. Recent Findings Pneumonia can be prevented by decreasing the duration of mechanical ventilation using daily paired spontaneous awakening and breathing trials, but not with early tracheostomy placement. Other useful prevention strategies include semirecumbent positioning and oral care. Mini-BAL is a sensitive and specific means of securing the diagnosis of pneumonia that does not require a physician to be present and is therefore especially useful in busy trauma centers. Summary Pneumonia is a frequent complication among trauma patients. Risk factors are largely unmodifiable. However, trauma centers can institute routine daily paired spontaneous awakening and breathing trials to decrease the duration of ventilation and incidence of pneumonia. Future research is needed to further characterize the microbiology of pneumonia among trauma patients.
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Affiliation(s)
- Morgan Schellenberg
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo St, IPT C5L100, Los Angeles, CA 90033 USA
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo St, IPT C5L100, Los Angeles, CA 90033 USA
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Abstract
Thoracic injuries account for 25% of all civilian deaths. Blunt force injuries are a subset of thoracic injuries and include injuries of the tracheobronchial tree, pleural space, and lung parenchyma. Early identification of these injuries during initial assessment and resuscitation is essential to reduce associated morbidity and mortality rates. Management of airway injuries includes definitive airway control with identification and repair of tracheobronchial injuries. Management of pneumothorax and hemothorax includes pleural space drainage and control of ongoing hemorrhage, along with monitoring for complications such as empyema and chylothorax. Injuries of the lung parenchyma, such as pulmonary contusion, may require support of oxygenation and ventilation through both conventional and nonconventional mechanical ventilation strategies. General strategies to improve pulmonary function and gas exchange include balanced fluid resuscitation to targeted volume-based resuscitation end points, positioning therapy, and pain management.
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Abstract
Thoracic injuries account for 25% of all civilian deaths. Blunt force injuries are a subset of thoracic injuries and include injuries of the tracheobronchial tree, pleural space, and lung parenchyma. Early identification of these injuries during initial assessment and resuscitation is essential to reduce associated morbidity and mortality rates. Management of airway injuries includes definitive airway control with identification and repair of tracheobronchial injuries. Management of pneumothorax and hemothorax includes pleural space drainage and control of ongoing hemorrhage, along with monitoring for complications such as empyema and chylothorax. Injuries of the lung parenchyma, such as pulmonary contusion, may require support of oxygenation and ventilation through both conventional and nonconventional mechanical ventilation strategies. General strategies to improve pulmonary function and gas exchange include balanced fluid resuscitation to targeted volume-based resuscitation end points, positioning therapy, and pain management.
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Affiliation(s)
- John J. Gallagher
- John J. Gallagher is Clinical Nurse Specialist/Trauma Program Manager, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
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Jin H, Tang LQ, Pan ZG, Peng N, Wen Q, Tang YQ, Su L. Ten-year retrospective analysis of multiple trauma complicated by pulmonary contusion. Mil Med Res 2014; 1:7. [PMID: 25722865 PMCID: PMC4336115 DOI: 10.1186/2054-9369-1-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study reports a 10-year retrospective analysis of multiple trauma complicated by pulmonary contusion. The purpose of this study is to ascertain the risk factors for mortality due to trauma in patients with pulmonary contusion, the impact of various treatment options for prognosis, and the risk factors for concurrent Acute Respiratory Distress Syndrome (ARDS). METHODS We retrospectively analyzed 252 trauma patients with lung contusion admitted to the General Hospital of Guangzhou Command from January 2000 to June 2011 by using the statistical processing system SPSS 17.0 for Windows. RESULTS We included 252 patients in our study, including 214 males and 38 females. The average age was 37.1 ± 14.9 years. There were 110 cases admitted to the ICU, of which 26 cases with ARDS. Nine of the 252 patients died. We compared those who survived with those who died by gender and age, the difference was not statistically significant (P = 0.199, P = 0.200). Separate univariate analysis of those who died and those who survived found that shock on admission (P = 0.000), coagulation disorders (P = 0.000), gastrointestinal bleeding (P = 0.02), the need for emergency surgery on admission (P = 0.000), pre-hospital intubation (P = 0.000), blood transfusion within 24 hours (P = 0.006), the use of mechanical ventilation (P = 0.000), and concurrent ARDS (P = 0.000) are poor prognosis risk factors. Further logistic analysis, including the admission GCS score (OR = 0.708, 95% CI 0.516-0.971, P = 0.032), ISS score (OR 1.135, 95% CI 1.006-1.280, P = 0.039), and concurrent ARDS (OR = 15.814, 95% CI 1.819-137.480, P = 0.012), identified the GCS score, ISS score and concurrent ARDS as independent risk factors of poor prognosis. Shock (OR = 9.121, 95% CI 0.857-97.060, P = 0.067) was also related to poor prognosis. Patients with injury factors such as road accident, falling injury, blunt injury and crush injury, et al.(P = 0.039), infection (P = 0.005), shock (P = 0.004), coagulation disorders (P = 0.006), emergency surgery (P = 0.01), pre-hospital intubation (P = 0.000), chest tube insertion (P = 0.004), blood transfusion (P = 0.000), usage of hormones (P = 0.002), phlegm (P = 0.000), ventilation (P = 0.000) were at a significantly increased risk for ARDS complications. CONCLUSIONS Those patients with multiple trauma and pulmonary contusion admitted to the hospital with shock, coagulopathy, a need for emergency surgery, pre-hospital intubation, and a need for mechanical ventilation could have a significantly increased risk of mortality and ARDS incidence. A risk for poor prognosis was associated with gastrointestinal bleeding. A high ISS score, high APACHE2, and low GCS score were independent risk factors for poor prognosis. If patients developed an infection or were given drainage, hormones, and phlegm treatment, they were at higher risk of ARDS. Pre-hospital intubation and drainage were independent risk factors for ARDS. In patients with ARDS, the ICU stay, total length of stay, and hospital costs might increase significantly. A GCS score < 5.5, APACHE 2 score > 16.5, and ISS score > 20.5 could be considered indicators of poor prognosis for patients with multiple trauma and lung contusion.
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Affiliation(s)
- Hui Jin
- Intensive Care Unit, General Hospital of Guangzhou Command, Guangzhou, 510000 China
| | - Li-Qun Tang
- Intensive Care Unit, General Hospital of Guangzhou Command, Guangzhou, 510000 China
| | - Zhi-Guo Pan
- Intensive Care Unit, General Hospital of Guangzhou Command, Guangzhou, 510000 China
| | - Na Peng
- Intensive Care Unit, General Hospital of Guangzhou Command, Guangzhou, 510000 China
| | - Qiang Wen
- Intensive Care Unit, General Hospital of Guangzhou Command, Guangzhou, 510000 China
| | - You-Qing Tang
- Intensive Care Unit, General Hospital of Guangzhou Command, Guangzhou, 510000 China
| | - Lei Su
- Intensive Care Unit, General Hospital of Guangzhou Command, Guangzhou, 510000 China
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Role of pulmonary artery reactivity and nitric oxide in injury and inflammation following lung contusion. Shock 2013; 39:278-85. [PMID: 23364426 DOI: 10.1097/shk.0b013e318281d6ed] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The mechanisms contributing to hypoxia in lung contusion (LC) remain unclear and not temporally associated with the peak onset of acute inflammation. We investigated the role of oxidative stress in alteration of pulmonary arterial (PA) reactivity following LC. In addition, the role of antioxidants in reversing this process was examined. PaO2 and PA reactivity were measured in rats subjected to bilateral LC. Rings were pretreated with a nitric oxide synthase (NOS) inhibitor, L-nitro arginine (10(-3) M), or PEG-superoxide dismutase (SOD) and PEG-catalase (CAT), or both (L-nitro arginine + SOD/CAT). Rings were constricted with norepinephrine and relaxed with an NOS agonist (A23187) or NO donor (SNAP [S-nitrosyl amino penicillamine]). Immunochemical and mass spectrometric quantification for nitrotyrosine was performed. Rats were hypoxemic at 4 h after contusion compared with controls, but recovered by 24 h (PaO(2)/FIO(2) ratio: baseline, 443 ± 28; 4 h, 288 ± 46; and 24 h, 417 ± 23). Pulmonary arterial constriction to NOS inhibition and relaxation to A23187 were impaired 4 h after LC. Pulmonary arterial relaxation to SNAP was decreased at 4 and 24 h after LC. These alterations in PA reactivity were reversed by SOD/CAT pretreatment. SOD1 and 2 mRNA were upregulated, and soluble guanylyl cyclase mRNA was downregulated 24 h after LC. Immunohistochemistry and mass spectrometry revealed that levels of 3-nitrotyrosine were increased markedly at 4 h following LC consistent with superoxide generation and formation of peroxynitrite. Collectively, these data suggest that consumption of NO due to excess superoxide resulting in peroxynitrite formation leads to diminished vascular reactivity following LC.
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Freixinet Gilart J, Hernández Rodríguez H, Martínez Vallina P, Moreno Balsalobre R, Rodríguez Suárez P. Normativa sobre diagnóstico y tratamiento de los traumatismos torácicos. Arch Bronconeumol 2011; 47:41-9. [DOI: 10.1016/j.arbres.2010.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 05/29/2010] [Indexed: 10/18/2022]
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Cobanoglu U, Melek M, Edirne Y. Chest radiography diagnosis of pulmonary contusion is associated with increased morbidity and mortality. Indian J Thorac Cardiovasc Surg 2010. [DOI: 10.1007/s12055-010-0010-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Mahlke L, Oestern S, Drost J, Frerichs A, Seekamp A. [Prophylactic ventilation of severely injured patients with thoracic trauma--does it always make sense?]. Unfallchirurg 2010; 112:938-41. [PMID: 19838660 DOI: 10.1007/s00113-009-1600-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
For therapy of blunt thoracic trauma in multiple injured patients, some studies have recommended prophylactic ventilation with kinetic therapy for 3-5 days. In contrast other clinics prefer to reduce the time of ventilation and to extubate as soon as possible. In this retrospective study our patient collective was investigated to find out if early extubation is linked to a higher complication rate. A total of 26 ventilated patients with severe thoracic trauma and an abbreviated injury scale score (AIS thorax) >3 were included in the study. The mean time of ventilation was 98.4 h and in patients without head injury 71.3 h. Out of 22 patients 4 had to be reintubated which had to be repeated for 2 patients. Of the patients 3 developed pneumonia but no cases of adult respiratory distress syndrome (ARDS) were observed. Of the patients 4 died due to other injuries. The mean stay on the intensive care unit was 6.3 days and the mean stay in hospital 22.6 days. Our findings indicate that even with early and aggressive weaning from a respirator with extensive lung contusions an adequate therapy of thorax trauma is possible without having a higher incidence of complications.
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Affiliation(s)
- L Mahlke
- Klinik für Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel.
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Marraro GA, Denaro C, Spada C, Luchetti M, Giansiracusa C. Selective medicated (saline + natural surfactant) bronchoalveolar lavage in unilateral lung contusion. A clinical randomized controlled trial. J Clin Monit Comput 2009; 24:73-81. [PMID: 20012912 DOI: 10.1007/s10877-009-9213-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 11/25/2009] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Open lung and low tidal volume ventilation appear to be a promising ventilation for chest trauma as it can reduce ARDS and improve outcome. Local therapy (e.g. BAL) can be synergic to remove from the lung the debris, mitigate inflammatory cascade and avoid damage spreading to not compromised lung areas. MATERIALS AND METHODS 44 pulmonary contused patients were randomized to receive broncho-suction and volume controlled low tidal volume ventilation-VCLTVV (Control Group) or the same ventilation plus medicated (saline + surfactant) BAL (Treatment Group). Tidal volume <10 ml/kg, PEEP of 10-12 cm H(2)O and PaO(2) 60-100 mm Hg and PaCO(2) 35-45 mm Hg were used in both groups. BAL was performed using a fiberscope. 4 boluses of 25 ml saline with 2.4 mg/ml of surfactant were introduced into each contused lobe in which, subsequently, 240 mg of surfactant was instilled. RESULTS All patients survived. In the Control Group 18 patients developed pneumonia, 5 ARDS and days of intubation were 11.50 (3.83) compared to 5.05 (1.21) of Treatment Group in which OI and PaO(2)/FiO(2) significantly improved from 36 h. CONCLUSIONS VCLTVV alone was not able to prevent ARDS and infection in the Control Group as the reduction of intubation. In the Treatment Group, VCLTVV and medicated BAL facilitated the removal of degradated lung material and recruited the contused lung regions, enabling the healing of the lung pathology.
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Affiliation(s)
- Giuseppe A Marraro
- Anesthesia and Intensive Care Department, A.O. Fatebenefratelli and Ophthalmiatric Hospital, Milan, Italy.
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Risk factors of mortality in road traffic injury patients with acute respiratory distress syndrome. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200806010-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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