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Edu S, Nicol A, Neuhaus V, McPherson D, Navsaria PH. Late video-assisted thoracoscopic surgery versus thoracostomy tube reinsertion for retained hemothorax after penetrating trauma, a prospective randomized control study. World J Surg 2024; 48:1555-1561. [PMID: 38588034 DOI: 10.1002/wjs.12181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Early video-assisted thoracoscopic surgery (VATS) is the recommended treatment of choice for retained hemothorax (RH). A prospective single-center randomized control study was conducted to compare outcomes between VATS and thoracostomy tube (TT) reinsertion for patients with RH after penetrating trauma in a resource constrained unit. Our hypothesis was that patients with a RH receiving VATS instead of TT reinsertion would have a shorter hospital stay and lesser complications. MATERIALS AND METHODS From January 2014 to November 2019, stable patients with thoracic penetrating trauma complicated with retained hemothoraces were randomized to either VATS or TT reinsertion. The outcomes were length of hospital stay (LOS) and complications. RESULTS Out of the 77 patients assessed for eligibility, 65 patients were randomized and 62 analyzed: 30 in the VATS arm and 32 in the TT reinsertion arm. Demographics and mechanisms of injury were comparable between the two arms. Length of hospital stay was: preprocedure: VATS 6.8 (+/-2.8) days and TT 6.6 (+/- 2.4) days (p = 0.932) and postprocedure: VATS 5.1 (+/-2.3) days, TT 7.1 (+/-6.3) days (p = 0.459), total LOS VATS 12 (+/- 3.9) days, and TT 14.4 (+/-7) days (p = 0.224). The TT arm had 15 complications compared to the VATS arm of four (p = 0.004). There were two additional procedures in the VATS arm and 10 in the TT arm (p = 0.014). CONCLUSION VATS proved to be the better treatment modality for RH with fewer complications and less need of additional procedures, while the LOS between the two groups was not statistically different.
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Affiliation(s)
- Sorin Edu
- Trauma Centre, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Andrew Nicol
- Trauma Centre, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Valentin Neuhaus
- Department of Trauma Surgery, University Hospital of Zurich, Zürich, Switzerland
| | - Deidre McPherson
- Trauma Centre, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Pradeep H Navsaria
- Trauma Centre, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Lee H, Kwon H, Kim CW, Hwangbo L. [Intervention for Chest Trauma and Large Vessel Injury]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:809-823. [PMID: 37559800 PMCID: PMC10407064 DOI: 10.3348/jksr.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/23/2023] [Accepted: 06/20/2023] [Indexed: 08/11/2023]
Abstract
Trauma is an injury to the body that involves multiple anatomical and pathophysiological changes caused by forces acting from outside the body. The number of patients with trauma is increasing as our society becomes more sophisticated. The importance and demand of traumatology are growing due to the development and spread of treatment and diagnostic technologies. In particular, damage to the large blood vessels of the chest can be life-threatening, and the sequelae are often severe; therefore, diagnostic and therapeutic methods are becoming increasingly important. Trauma to non-aortic vessels of the thorax and aorta results in varying degrees of physical damage depending on the mechanism of the accident and anatomical damage involved. The main damage is hemorrhage from non-aortic vessels of the thorax and aorta, accompanied by hemodynamic instability and coagulation disorders, which can be life-threatening. Immediate diagnosis and rapid therapeutic access can often improve the prognosis. The treatment of trauma can be surgical or interventional, depending on the patient's condition. Among them, interventional procedures are increasingly gaining popularity owing to their convenience, rapidity, and high therapeutic effectiveness, with increasing use in more trauma centers worldwide. Typical interventional procedures for patients with thoracic trauma include embolization for non-aortic injuries and thoracic endovascular aortic repair for aortic injuries. These procedures have many advantages over surgical treatments, such as fewer internal or surgical side effects, and can be performed more quickly than surgical procedures, contributing to improved outcomes for patients with trauma.
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The Volume of Thoracic Irrigation Is Associated With Length of Stay in Patients With Traumatic Hemothorax. J Surg Res 2022; 279:62-71. [PMID: 35724544 DOI: 10.1016/j.jss.2022.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/15/2022] [Accepted: 05/21/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Irrigation of the thoracic cavity at tube thoracostomy (TT) placement may decrease the rate of a retained hemothorax (RHTX); however, other resource utilization outcomes have not yet been quantified. This study evaluated the association of thoracic irrigation during TT with the length of stay and outcomes in patients with traumatic hemothorax (HTX). METHODS A retrospective chart review was performed of adult patients receiving a TT for HTX at a single, urban Level 1 Trauma Center from January 2019 to December 2020. Those who underwent irrigation during TT at the discretion of the trauma surgeon were compared to a control of standard TT without irrigation. Death within 30 d, as well as TTs, placed at outside hospitals, during traumatic arrest or thoracic procedures, and for isolated pneumothoraces were excluded. The primary outcome was the length of stay as hospital-free, ICU-free, and ventilator-free days (30-day benchmark). Subgroup analysis by irrigation volume was conducted using one-way ANOVA testing with P < 0.05 considered statistically significant. RESULTS Eighty-two (41.4%) of 198 patients underwent irrigation during TT placement. Secondary interventions, thoracic infections, and TT duration were not statistically different in the irrigated cohort. Hospital-free and ICU-free days were higher in the irrigated patients than in the controls. Groups irrigated with ≥1000 mL had significant more hospital-free days (P = 0.007) than those receiving less than 1000 mL. CONCLUSIONS Patients with traumatic HTX who underwent thoracic irrigation at the time of TT placement had decreased hospital and ICU days compared to standard TT placement alone. Specifically, our study demonstrated that patients irrigated with a volume of at least 1000 mL had greater hospital-free days compared to those irrigated with less than 1000 mL.
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Lewis BT, Herr KD, Hamlin SA, Henry T, Little BP, Naeger DM, Hanna TN. Imaging Manifestations of Chest Trauma. Radiographics 2021; 41:1321-1334. [PMID: 34270354 DOI: 10.1148/rg.2021210042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Trauma is the leading cause of death among individuals under 40 years of age, and pulmonary trauma is common in high-impact injuries. Unlike most other organs, the lung is elastic and distensible, with a physiologic capacity to withstand significant changes in contour and volume. The most common types of lung parenchymal injury are contusions, lacerations, and hematomas, each having characteristic imaging appearances. A less common type of lung injury is herniation. Chest radiography is often the first-line imaging modality performed in the assessment of the acutely injured patient, although there are inherent limitations in the use of this modality in trauma. CT images are more accurate for the assessment of the nature and extent of pulmonary injury than the single-view anteroposterior chest radiograph that is typically obtained in the trauma bay. However, the primary limitations of CT concern the need to transport the patient to the CT scanner and a longer processing time. The American Association for the Surgery of Trauma has established the most widely used grading scale to describe lung injury, which serves to communicate severity, guide management, and provide useful prognostic factors in a systematic fashion. The authors provide an in-depth exploration of the most common types of pulmonary parenchymal, pleural, and airway injuries. Injury grading, patient management, and potential complications of pulmonary injury are also discussed. ©RSNA, 2021.
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Affiliation(s)
- Brittany T Lewis
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
| | - Keith D Herr
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
| | - Scott A Hamlin
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
| | - Travis Henry
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
| | - Brent P Little
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
| | - David M Naeger
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
| | - Tarek N Hanna
- From the Department of Radiology and Imaging Sciences, Emory University, 550 Peachtree Rd, Atlanta GA 30308 (B.T.L., K.D.H., S.A.H., T.N.H.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.H.); Department of Radiology, Harvard Medical School, Boston, Mass (B.P.L.); Department of Radiology, Denver Health and Hospital Authority, Denver, Colo (D.M.N.); and Department of Radiology, University of Colorado, Denver, Colo (D.M.N.)
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Fonseca AZ, Kunizaki E, Waisberg J, Ribeiro MAF. Managing tube thoracostomy with thoracic ultrasound: results from a randomized pilot study. Eur J Trauma Emerg Surg 2020; 48:973-979. [PMID: 33244615 DOI: 10.1007/s00068-020-01554-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Tube thoracostomy (TT) is a simple and a life-saving procedure; nevertheless, it carries morbidity, even after its removal. Currently, TT is managed and removed by chest X-ray (CXR) evaluation. There are limitations and these are directly linked to complications. The use of thoracic ultrasound (US) has already been established in the diagnosis of pneumothorax (PTX) and hemothorax (HTX); its use, in substitution of CXR can lead to improvement in care. Our aim is to evaluate the efficiency and safety of US in the management of TT. METHODS Prospective and randomized study with patients requiring TT. They were divided in groups according to their thoracic injuries (PTX and HTX) and randomized into two groups according to TT management: US and CXR. Data collected included gender, age, mechanism of injury, days to TT removal, complications after TT removal and presence of mechanical ventilation. RESULTS Sixty-one patients were randomized, of which 68.8% were male. The most frequent diagnosis was PTX, present in 37 cases. Median time for TT removal was 2.5 days in the US group and 4.9 in the control group (p = 0.009). The complication rate was 6.6%, with no morbidity in the US group. TT removal in patients with mechanical ventilation did not increase the incidence of complications. CONCLUSIONS The use of US in the management is efficient and safe. It allows early TT removal regardless the cause of the thoracic injury.
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Affiliation(s)
- Alexandre Zanchenko Fonseca
- Programa de Pós-Graduação Do Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Av. Ibirapuera, 981 - 2º andar, Vila Clementino, São Paulo, SP, 04029-000, Brazil.
| | - Eric Kunizaki
- Programa de Pós-Graduação Do Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Av. Ibirapuera, 981 - 2º andar, Vila Clementino, São Paulo, SP, 04029-000, Brazil
| | - Jaques Waisberg
- Programa de Pós-Graduação Do Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Av. Ibirapuera, 981 - 2º andar, Vila Clementino, São Paulo, SP, 04029-000, Brazil
| | - Marcelo Augusto Fontenelle Ribeiro
- Programa de Pós-Graduação Do Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Av. Ibirapuera, 981 - 2º andar, Vila Clementino, São Paulo, SP, 04029-000, Brazil
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Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol 2020; 23:125-138. [PMID: 32417043 PMCID: PMC7296362 DOI: 10.1016/j.cjtee.2020.04.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 03/15/2020] [Accepted: 04/08/2020] [Indexed: 02/04/2023] Open
Abstract
Physical traumas are tragic and multifaceted injuries that suddenly threaten life. Although it is the third most common cause of death in all age groups, one out of four trauma patients die due to thoracic injury or its complications. Blunt injuries constitute the majority of chest trauma. This indicates the importance of chest trauma among all traumas. Blunt chest trauma is usually caused by motor vehicle accident, falling from height, blunt instrument injury and physical assault. As a result of chest trauma, many injuries may occur, such as pulmonary injuries, and these require urgent intervention. Chest wall and pulmonary injuries range from rib fractures to flail chest, pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries. Following these injuries, patients may present with a simple dyspnea or even respiratory arrest. For such patient, it is important to understand the treatment logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries. This is because only 10% of thoracic trauma patients require surgical operation and the remaining 90% can be treated with simple methods such as appropriate airway, oxygen support, maneuvers, volume support and tube thoracostomy. Adequate pain control in chest trauma is sometimes the most basic and best treatment. With definite diagnosis, the morbidity and mortality can be significantly reduced by simple treatment methods.
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