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Rathia SK, Tp M, Anand V, Yusuf S, Goel AK, T P. Trivial Blunt Chest Trauma Leading to Acute Respiratory Distress Syndrome in a Child. Cureus 2023; 15:e42132. [PMID: 37602040 PMCID: PMC10437144 DOI: 10.7759/cureus.42132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Both blunt and penetrating chest trauma in children are less common than in adults but cause severe acute morbidity and mortality. As the literature suggests, pulmonary contusion is the most common chest injury in children, occurring in more than half of all blunt chest trauma cases. Even patients with blunt injuries are likely to have a longer hospital stay. The difference in physiological and anatomical variations in children compared to adults makes it more difficult from the diagnosis, management, and monitoring perspectives. A thorough physical examination is needed with close clinical monitoring, and additional vigilance is important during the management of a child. The physiologic consequences, such as the dreaded complication of alveolar hemorrhage and pulmonary parenchymal destruction, usually manifest within a few hours of the trauma and can take up to seven days to recover. Hence, timely diagnosis is crucial during the emergency evaluation. The clinical diagnosis can be supported by a special imaging modality in the form of chest computed tomography (CT), which confirms the radiological parenchymal destruction with high sensitivity. Management is mostly supportive to start with and includes high-flow oxygen, ventilatory pressure support as needed for the severity of acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), judicious fluid administration, control of the pain associated with bony and thoracic soft tissue injuries, and careful hemodynamic monitoring for other complications and sequelae likely to develop. Here, we report an interesting case of a 10-year-old male child presenting to the Pediatric Emergency Department with acute moderate-to-severe respiratory distress that developed after two days of a few vomiting episodes along with non-specific lower chest and substernal pain following blunt trauma to the chest. The injury was trivial in nature as described by the father caused by an accidental fall on a small pile of bricks while playing near his home. After triaging under the red category, the child was managed in line with acute respiratory distress. We ruled out pneumothorax, hemorrhagic pleural effusion or pericardial effusion, and other evidence of invasive chest as well as gross abdominal injuries by comprehensive but focused history and clinical examinations, including adjuncts such as point-of-care ultrasound) and chest X-ray (CXR). Although the initial arterial blood gas analyses were suggestive of a mild form of ARDS or ALI by the criteria based on the P:F ratio (PaO2 to FiO2 ratio, which was between 200 and 300 for the case), the CXR and the chest CT revealed that the child had significant lung parenchymal injury in the form of bilateral fluffy pulmonary infiltrates. This case indicates that even a trivial blunt trauma can induce certain mechanisms of lung injury, leading to severe manifestations and sometimes fatal complications such as pulmonary contusion, hemorrhage, and ARDS.
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Affiliation(s)
- Santosh K Rathia
- Trauma and Emergency/Pediatric Emergency Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Murugan Tp
- Pediatric Emergency Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Varun Anand
- Trauma and Emergency/Pediatric Emergency Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Samreen Yusuf
- Pediatric Emergency Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Anil Kumar Goel
- Pediatrics, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Pugazhenthan T
- Pharmacology and Therapeutics, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Lodhia JV, Eyre L, Smith M, Toth L, Troxler M, Milton RS. Management of thoracic trauma. Anaesthesia 2023; 78:225-235. [PMID: 36572548 DOI: 10.1111/anae.15934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/28/2022]
Abstract
Managing major thoracic trauma begins with identifying and anticipating injuries associated with the mechanism of injury. The key aims are to reduce early mortality and the impact of associated complications to expedite recovery and restore the patient to their pre-injury state. While imaging is imperative to identify the extent of thoracic trauma, some pathology may require immediate treatment. The majority can be managed with adequate pleural drainage, but respiratory failure and poor gas exchange may require either non-invasive or invasive ventilation. Ventilation strategies to protect from complications such as barotrauma, volutrauma and ventilator-induced lung injury are important to consider. The management of pain is vital in reducing respiratory complications. A multimodal strategy using local, regional and systemic analgesia may mitigate respiratory side effects of opioid use. With optimal pain management, physiotherapy can be fully utilised to reduce respiratory complications and enhance early recovery. Thoracic surgeons should be consulted early for consideration of surgical management of specific injuries. With a greater understanding of the mechanisms of injury and the appropriate use of available resources, favourable outcomes can be reached in this cohort of patients. Overall, a multidisciplinary and holistic approach results in the best patient outcomes.
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Affiliation(s)
- J V Lodhia
- Department of Thoracic Surgery, St James University Hospital, Leeds, UK
| | - L Eyre
- Department of Anaesthesia, St James University Hospital, Leeds, UK
| | - M Smith
- Department of Rehabilitation Medicine, Leeds General Infirmary, Leeds, UK
| | - L Toth
- Department of Orthopaedics, Leeds General Infirmary, Leeds, UK
| | - M Troxler
- Department of Vascular Surgery, Leeds General Infirmary, Leeds, UK
| | - R S Milton
- Department of Thoracic Surgery, St James University Hospital, Leeds, UK
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In-Hospital Predictors of Need for Ventilatory Support and Mortality in Chest Trauma: A Multicenter Retrospective Study. J Clin Med 2023; 12:jcm12020714. [PMID: 36675639 PMCID: PMC9863024 DOI: 10.3390/jcm12020714] [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: 12/07/2022] [Revised: 01/02/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Chest trauma management often requires the use of invasive and non-invasive ventilation. To date, only a few studies investigated the predictors of the need for ventilatory support. Data on 1080 patients with chest trauma managed in two different centers were retrospectively analyzed. Univariate and multivariate analyses were performed to identify the predictors of tracheal intubation (TI), non-invasive mechanical ventilation (NIMV), and mortality. Rib fractures (p = 0.0001) fracture of the scapula, clavicle, or sternum (p = 0.045), hemothorax (p = 0.0035) pulmonary contusion (p = 0.0241), and a high Injury Severity Score (ISS) (p ≤ 0001) emerged as independent predictors of the need of TI. Rib fractures (p = 0.0009) hemothorax (p = 0.0027), pulmonary contusion (p = 0.0160) and a high ISS (p = 0.0001) were independent predictors of NIMV. The center of trauma care (p = 0.0279), age (p < 0.0001) peripheral oxygen saturation in the emergency department (p = 0.0010), ISS (p < 0.0001), and Revised Trauma Score (RTS) (p < 0.0001) were independent predictors of outcome. In conclusion, patients who do not require TI, while mandating ventilatory support with selected types of injuries and severity scores, are more likely to be subjected to NIMV. Trauma team expertise and the level of the trauma center could influence patient outcomes.
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Milson N, Treger I, Vered M, Acker A, Kalichman L. Hospital-Based Rehabilitation of Patients Who Had Undergone an Open Reduction and Internal Fixation of the Ribs Due to a Flail Chest: Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16026. [PMID: 36498097 PMCID: PMC9739889 DOI: 10.3390/ijerph192316026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
Flail chest, a severe chest injury, is caused by multiple rib fractures. The open reduction and internal fixation (ORIF) of rib fractures is an effective treatment; however, the patients' subsequent condition remains unsatisfactory in terms of the activities of daily living (ADL) and pain. No research study has, as yet, reported on hospital-based rehabilitation of patients who had undergone an ORIF. Our aim was to evaluate the efficacy of hospital-based rehabilitation of flail chest post-ORIF patients. Physical therapists assessed the pain, functional independence measure (FIM), and the Berg balance test. A total of three females and four males (mean age 59.43 ± 18.88) were hospitalized. A significant reduction in pain was observed (7.00 ± 1.83 upon admission to 4.10 ± 2.05 pre-discharge (Z = -2.07, p = 0.027). A significant improvement in FIM (69.43 ± 14.86 upon admission to 113.57 ± 6.40 pre-discharge, Z = -2.37, p = 0.018), and the Berg balance test (35.23 ± 5.87 upon admission to 49.50 ± 3.40 pre-discharge, Z = -2.37, p = 0.018), was observed. Upon admission, all the patients required moderate to complete ADL assistance. Upon discharge, all were independent for all ADL functions. Patients after flail chest post-ORIF can benefit from hospital-based rehabilitation.
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Affiliation(s)
- Nehama Milson
- Rehabilitation Department, Soroka University Medical Center, Beer Sheva 84101, Israel
| | - Iuly Treger
- Rehabilitation Department, Soroka University Medical Center, Beer Sheva 84101, Israel
- Department of Medicine, Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Michal Vered
- Rehabilitation Department, Soroka University Medical Center, Beer Sheva 84101, Israel
| | - Asaf Acker
- Rehabilitation Department, Soroka University Medical Center, Beer Sheva 84101, Israel
- Department of Medicine, Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel
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Ramin S, Arcelli M, Bouchdoug K, Laumon T, Duflos C, De Jong A, Jaber S, Capdevila X, Charbit J. Driving pressure is not predictive of ARDS outcome in chest trauma patients under mechanical ventilation. Anaesth Crit Care Pain Med 2022; 41:101095. [PMID: 35489710 DOI: 10.1016/j.accpm.2022.101095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/27/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The relationship between the driving pressure of the respiratory system (ΔPrs) under mechanical ventilation and worse outcome has never been studied specifically in chest trauma patients. The objective of the present study was to assess in cases of chest trauma the relationship between ΔPrs and severity of acute respiratory distress syndrome (ARDS) or death and length of stay. METHODS A retrospective analysis of severe trauma patients (ISS > 15) with chest injuries admitted to the Trauma Centre from January 2010 to December 2018 was performed. Patients who received mechanical ventilation were included in our analysis. Mechanical ventilation parameters and ΔPrs were recorded during the stay in the intensive care unit. Association of ΔPrs with mortality and outcomes was specifically studied at the onset of ARDS (ΔPrs-ARDS) by receiver operator characteristic curve analysis, Kaplan-Meier curves, and multivariate analysis. RESULTS Among the 266 chest trauma patients studied, 194 (73%) developed ARDS. ΔPrs was significantly higher in the ARDS group versus in the no ARDS group (11.6 ± 2.4 cm H2O vs. 10.9 ± 1.9 cm H2O, p = 0.04). Among the patients with ARDS, no difference according to the duration of mechanical ventilation was found between the high ΔPrs group (ΔPrs-ARDS > 14 cm H2O) and the low ΔPrs group (ΔPrs-ARDS ≤ 14 cm H2O), (p = 0.75). ΔPrs-ARDS was not independently associated with the duration of mechanical ventilation (hazard ratio [HR], 1.006; 95% CI, 0.95-1.07; p = 0.8) or mortality (HR, 1.07; 95% CI, 0.9-1.28; p = 0.45). High mechanical power (≥ 12 J/min) was associated with a lower time for weaning of mechanical ventilation in Kaplan-Meier curves but not in multivariate analysis (HR, 0.98; 95% CI, 0.94-1.02; p = 0.22). CONCLUSION A high ΔPrs-ARDS was not significantly associated with an increase in mechanical ventilation duration or mortality risk in ARDS patients with chest trauma in contrast with medical patients.
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Affiliation(s)
- Severin Ramin
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France; OcciTRAUMA Network, Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, France.
| | - Matteo Arcelli
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France; OcciTRAUMA Network, Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, France
| | - Karim Bouchdoug
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France; OcciTRAUMA Network, Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, France; Department of Statistical Analysis, Montpellier, France
| | - Thomas Laumon
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France; OcciTRAUMA Network, Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, France
| | | | - Audrey De Jong
- Department of Anaesthesiology and Critical Care Medicine, Saint Eloi University Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Samir Jaber
- Department of Anaesthesiology and Critical Care Medicine, Saint Eloi University Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Xavier Capdevila
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France; OcciTRAUMA Network, Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, France
| | - Jonathan Charbit
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France; OcciTRAUMA Network, Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, France
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Picetti E, Rosenstein I, Balogh ZJ, Catena F, Taccone FS, Fornaciari A, Votta D, Badenes R, Bilotta F. Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review. J Clin Med 2021; 11:18. [PMID: 35011760 PMCID: PMC8745292 DOI: 10.3390/jcm11010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 01/28/2023] Open
Abstract
Managing the acute phase after a severe traumatic brain injury (TBI) with polytrauma represents a challenging situation for every trauma team member. A worldwide variability in the management of these complex patients has been reported in recent studies. Moreover, limited evidence regarding this topic is available, mainly due to the lack of well-designed studies. Anesthesiologists, as trauma team members, should be familiar with all the issues related to the management of these patients. In this narrative review, we summarize the available evidence in this setting, focusing on perioperative brain protection, cardiorespiratory optimization, and preservation of the coagulative function. An overview on simultaneous multisystem surgery (SMS) is also presented.
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Affiliation(s)
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, 43100 Parma, Italy; (E.P.); (A.F.)
| | - Israel Rosenstein
- Department of Anesthesiology and Critical Care, Policlinico Umberto I Hospital, La Sapienza University of Rome, 00161 Rome, Italy; (I.R.); (D.V.); (F.B.)
| | - Zsolt J. Balogh
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle 2305, Australia;
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital, 47521 Cesena, Italy;
| | - Fabio S. Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium;
| | - Anna Fornaciari
- Department of Anesthesia and Intensive Care, Parma University Hospital, 43100 Parma, Italy; (E.P.); (A.F.)
| | - Danilo Votta
- Department of Anesthesiology and Critical Care, Policlinico Umberto I Hospital, La Sapienza University of Rome, 00161 Rome, Italy; (I.R.); (D.V.); (F.B.)
| | - Rafael Badenes
- Department of Anesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, 46010 Valencia, Spain
| | - Federico Bilotta
- Department of Anesthesiology and Critical Care, Policlinico Umberto I Hospital, La Sapienza University of Rome, 00161 Rome, Italy; (I.R.); (D.V.); (F.B.)
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Mohrsen S, McMahon N, Corfield A, McKee S. Complications associated with pre-hospital open thoracostomies: a rapid review. Scand J Trauma Resusc Emerg Med 2021; 29:166. [PMID: 34863280 PMCID: PMC8643006 DOI: 10.1186/s13049-021-00976-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/04/2021] [Indexed: 02/26/2023] Open
Abstract
Background Open thoracostomies have become the standard of care in pre-hospital critical care in patients with chest injuries receiving positive pressure ventilation. The procedure has embedded itself as a rapid method to decompress air or fluid in the chest cavity since its original description in 1995, with a complication rate equal to or better than the out-of-hospital insertion of indwelling pleural catheters. A literature review was performed to explore potential negative implications of open thoracostomies and discuss its role in mechanically ventilated patients without clinical features of pneumothorax. Main findings A rapid review of key healthcare databases showed a significant rate of complications associated with pre-hospital open thoracostomies. Of 352 thoracostomies included in the final analysis, 10.6% (n = 38) led to complications of which most were related to operator error or infection (n = 26). Pneumothoraces were missed in 2.2% (n = 8) of all cases. Conclusion There is an appreciable complication rate associated with pre-hospital open thoracostomy. Based on a risk/benefit decision for individual patients, it may be appropriate to withhold intervention in the absence of clinical features, but consideration must be given to the environment where the patient will be monitored during care and transfer. Chest ultrasound can be an effective assessment adjunct to rule in pneumothorax, and may have a role in mitigating the rate of missed cases. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00976-1.
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Affiliation(s)
- Stian Mohrsen
- ScotSTAR, Emergency Medical Retrieval Service, 180 Abbotsinch Road, Paisley, PA2 3RY, UK. .,Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
| | - Niall McMahon
- ScotSTAR, Emergency Medical Retrieval Service, 180 Abbotsinch Road, Paisley, PA2 3RY, UK
| | - Alasdair Corfield
- ScotSTAR, Emergency Medical Retrieval Service, 180 Abbotsinch Road, Paisley, PA2 3RY, UK
| | - Sinéad McKee
- Department of Nursing, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
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Sharrock MK, Shannon B, Garcia Gonzalez C, Clair TS, Mitra B, Noonan M, Fitzgerald PM, Olaussen A. Prehospital paramedic pleural decompression: A systematic review. Injury 2021; 52:2778-2786. [PMID: 34454722 DOI: 10.1016/j.injury.2021.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tension pneumothorax (TPT) is a frequent life-threat following thoracic injury. Time-critical decompression of the pleural cavity improves survival. However, whilst paramedics utilise needle thoracostomy (NT) and/or finger thoracostomy (FT) in the prehospital setting, the superiority of one technique over the other remains unknown. AIM To determine and compare procedural success, complications and mortality between NT and FT for treatment of a suspected TPT when performed by paramedics. METHODS We searched four databases (Ovid Medline, PubMed, CINAHL and Embase) from their commencement until 25th August 2020. Studies were included if they analysed patients suffering from a suspected TPT who were treated in the prehospital setting with a NT or FT by paramedics (or local equivalent nonphysicians). RESULTS The search yielded 293 articles after duplicates were removed of which 19 were included for final analysis. Seventeen studies were retrospective (8 cohort; 7 case series; 2 case control) and two were prospective cohort studies. Only one study was comparative, and none were randomised controlled trials. Most studies were conducted in the USA (n=13) and the remaining in Australia (n=4), Switzerland (n=1) and Canada (n=1). Mortality ranged from 12.5% to 79% for NT and 64.7% to 92.9% for FT patients. A higher proportion of complications were reported among patients managed with NT (13.7%) compared to FT (4.8%). We extracted three common themes from the papers of what constituted as a successful pleural decompression; vital signs improvement, successful pleural cavity access and absence of TPT at hospital arrival. CONCLUSION Evidence surrounding prehospital pleural decompression of a TPT by paramedics is limited. Available literature suggests that both FT and NT are safe for pleural decompression, however both procedures have associated complications. Additional high-quality evidence and comparative studies investigating the outcomes of interest is necessary to determine if and which procedure is superior in the prehospital setting.
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Affiliation(s)
- Ms Kelsey Sharrock
- Department of Paramedicine, Monash University, Melbourne, Australia; Ambulance Victoria, Doncaster, Melbourne, Australia
| | - Brendan Shannon
- Department of Paramedicine, Monash University, Melbourne, Australia; Ambulance Victoria, Doncaster, Melbourne, Australia
| | | | - Toby St Clair
- Department of Paramedicine, Monash University, Melbourne, Australia; Ambulance Victoria, Doncaster, Melbourne, Australia; The Royal Children's Hospital, Department of Trauma, Melbourne, Australia
| | - Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University
| | - Michael Noonan
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia
| | - Prof Mark Fitzgerald
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Alexander Olaussen
- Department of Paramedicine, Monash University, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia.
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Sultana J, Rahman QB, Chowdhury EH, Juyena NS, Bashar MA. Management of cardiorespiratory function of rabbits by a customized chest drain: An experimental study. J Adv Vet Anim Res 2021; 8:138-145. [PMID: 33860024 PMCID: PMC8043342 DOI: 10.5455/javar.2021.h496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/15/2020] [Accepted: 12/24/2020] [Indexed: 11/10/2022] Open
Abstract
Objective: This study aimed to salvage the study population from the fatality that occurs due to iatrogenic injury to the thoracic cavity’s pleural membrane. Materials and Methods: An experimental study of temporomandibular joint arthroplasty with costochondral graft was carried out on 72 healthy ‘Oryctolagus cuniculus’ species of male rabbits. The rabbits were distributed into two age groups: growing (3–4 months) and adult (12–18 months). All the procedures were carried out under general anesthesia with xylazine hydrochloride and ketamine hydrochloride after calculating the doses, maintained by halothane and O2 inhalations. Out of 72 rabbits, 33 rabbits had accidental perforation of the pleural membrane observed that required a chest drain. Results: In this study, 21 (63.64%) rabbits received chest drain and salvaged. The rest of the rabbits (n = 12; 36.36%) that did not receive any chest drain and died. Most of the rabbits (n = 17; 81%) were under the growing group, weighing less than 2 kg and four (19%) were adult rabbits. Conclusion: This manual chest drain is life-saving for rabbits. It is a new addition to the advancement of thoracic surgery on animals. It is cost-effective and safe. The developed customized drainage system may make it easier to harvest the costochondral graft-related experiments.
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Affiliation(s)
- Jachmen Sultana
- Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Quazi Billur Rahman
- Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Emdadul Haque Chowdhury
- Department of Pathology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Nasrin Sultana Juyena
- Department of Surgery and Obstetrics, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Abul Bashar
- Department of Paediatrics, Cumilla Medical College Hospital, Cumilla, Bangladesh
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Dicker SA, Lisciandro GR, Newell SM, Johnson JA. Diagnosis of pulmonary contusions with point-of-care lung ultrasonography and thoracic radiography compared to thoracic computed tomography in dogs with motor vehicle trauma: 29 cases (2017-2018). J Vet Emerg Crit Care (San Antonio) 2020; 30:638-646. [PMID: 33085212 DOI: 10.1111/vec.13021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/29/2019] [Accepted: 05/10/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the accuracy of lung ultrasound (LUS) using the Veterinary Bedside Lung Ultrasound Examination (VetBLUE) protocol and 3-view thoracic radiographs (TXR) compared to thoracic computed tomography (TCT) for diagnosing the presence and quantification of pulmonary contusions (PC). DESIGN Prospective cohort study conducted from February 2017 to June 2018. SETTING Private emergency and referral center. ANIMALS Thirty-two dogs having sustained motor vehicle trauma were consecutively enrolled. Three dogs were excluded from statistical analysis. All dogs survived to hospital discharge. INTERVENTIONS Within 24 hours of sustaining trauma, dogs had LUS, TXR, and TCT performed. Using the VetBLUE protocol, LUS PC were scored according to the presence and number of B-lines and C-lines, indicating extravascular lung water. Thoracic radiographs and TCT were scored for PC in a similar topographical pattern to the VetBLUE protocol. Lung ultrasound and TXR were compared to "gold standard" TCT for the presence and quantification of PC. MEASUREMENTS AND MAIN RESULTS On TCT, 21 of 29 (72.4%) dogs were positive and 8 of 29 (27.6%) dogs were negative for PC. When LUS was compared to TCT, 19 of 21 dogs were positive for PC (90.5% sensitivity) and 7 of 8 dogs were negative (87.5% specificity) for PC. LUS PC score correlated strongly with TCT PC score (R = 0.8, P < 0.001). When TXR was compared to TCT, 14 of 21 dogs were positive for PC (66.7% sensitivity) and 7 of 8 dogs were negative (87.5% specificity) for PC. TXR PC score correlated strongly with TCT PC score (R = 0.74, P < 0.001). CONCLUSIONS In this population of dogs with motor vehicle trauma, LUS had high sensitivity for diagnosis of PC when compared to "gold standard" TCT. LUS provides reliable diagnosis of PC after trauma. More patients with PC were identified with LUS than with TXR, and additional studies are warranted to determine whether this increased sensitivity is statistically significant.
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11
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Sikander N, Ahmad T, Shaikh KA, Abid A, Mazcuri M, Nasreen S. Analysis of Injury Patterns and Outcomes of Blunt Thoracic Trauma in Elderly Patients. Cureus 2020; 12:e9974. [PMID: 32850270 PMCID: PMC7445091 DOI: 10.7759/cureus.9974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction In the elderly population, trauma is a leading cause of utilization of healthcare, institutionalization, disability, and mortality. In this study, we will assess the injury patterns and the factors associated with the outcomes of blunt thoracic trauma in elderly individuals. Methods This prospective observational study was conducted in the Department of Thoracic Surgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from September 2019 to April 2020. The study included patients of both genders aged 60 years and above with blunt thoracic trauma. Patients with concomitant neurological injuries and penetrating trauma to the chest were excluded. Results There were a total of 80 patients in this study; majority were males (n = 66 [82.5%]). The mean age was 70.18 ± 8.3 years. Road traffic accident was the most common mode of injury (n = 45 [56.3%]) followed by fall (n = 32 [40%]). Hemothorax and hemopneumothorax were the most common primary diagnosis. Rib fractures were encountered in 72 (90%) patients. Mortality rate was 21.3% (n = 17). Factors significantly related to mortality were age ≥ 80 years (p = 0.00), tension pneumothorax (p = 0.036), pre-existing cardiopulmonary disease (p = 0.032), blood loss ≥ 500 mL (p = 0.004), flail chest (p = 0.018), and chest trauma score ≥ 5 (p = 0.001). Mean hospital stay in our study was 5.3 ± 3.4 days. Factors lengthening hospital stay by more than five days included lung contusion (p = 0.02), more than two rib fractures (p = 0.004), hemopneumothorax (p = 0.026), pneumonia (p = 0.003), acute respiratory distress syndrome (p = 0.003), and flail chest (p = 0.013). Conclusions Elderly patients with blunt thoracic trauma have higher mortality. Proactive evaluation of injuries using the chest trauma score in the elderly population helps in recognizing patients at high risk of mortality and helps in the timely management to prevent adverse outcomes.
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Affiliation(s)
- Nazish Sikander
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Tanveer Ahmad
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Khalil A Shaikh
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Ambreen Abid
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Misauq Mazcuri
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Shagufta Nasreen
- Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
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12
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Profile of Chest Injuries and Oxygen Therapy in Trauma Patients with Acute Respiratory Failure after the Jiangsu Tornado in China: A Retrospective Study. Prehosp Disaster Med 2020; 35:335-340. [PMID: 32200770 DOI: 10.1017/s1049023x20000345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this study was to analyze the profile of chest injuries, oxygen therapy for respiratory failure, and the outcomes of victims after the Jiangsu tornado, which occurred on June 23, 2016 in Yancheng City, Jiangsu Province, China. METHODS The clinical records of 144 patients referred to Yancheng City No.1 People's Hospital from June 23 through June 25 were retrospectively investigated. Of those patients, 68 (47.2%) sustained major chest injuries. The demographic details, trauma history, details of injuries and Abbreviated Injury Scores (AIS), therapy for respiratory failure, surgical procedures, length of intensive care unit (ICU) and hospital stay, and mortality were analyzed. RESULTS Of the 68 patients, 41 (60.3%) were female and 27 (39.7%) were male. The average age of the injured patients was 57.1 years. Forty-six patients (67.6%) suffered from polytrauma. The mean thoracic AIS of the victims was calculated as 2.85 (SD = 0.76). Rib fracture was the most common chest injury, noted in 56 patients (82.4%). Pulmonary contusion was the next most frequent injury, occurring in 12 patients (17.7%). Ten patients with severe chest trauma were admitted to ICU. The median ICU stay was 11.7 (SD = 8.5) days. Five patients required intubation and ventilation, one patient was treated with noninvasive positive pressure ventilation (NPPV), and four patients were treated with high-flow nasal cannula (HFNC). Three patients died during hospitalization. The hospital mortality was 4.41%. CONCLUSIONS Chest trauma was a common type of injury after tornado. The most frequent thoracic injuries were rib fractures and pulmonary contusion. Severe chest trauma is usually associated with a high incidence of respiratory support requirements and a long length of stay in the ICU. Early initiation of appropriate oxygen therapy was vital to restoring normal respiratory function and saving lives. Going forward, HFNC might be an effective and well-tolerated therapeutic addition to the management of acute respiratory failure in chest trauma.
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13
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Marro A, Chan V, Haas B, Ditkofsky N. Blunt chest trauma: classification and management. Emerg Radiol 2019; 26:557-566. [DOI: 10.1007/s10140-019-01705-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
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14
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Ramin S, Charbit J, Jaber S, Capdevila X. Acute respiratory distress syndrome after chest trauma: Epidemiology, specific physiopathology and ventilation strategies. Anaesth Crit Care Pain Med 2019; 38:265-276. [DOI: 10.1016/j.accpm.2018.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 01/07/2023]
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15
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Gonzalez MN, Sethi A, McGavin J, Trehan G. Acute-Onset Quadriparesis After Placement of Thoracic Epidural: A Case Report. A A Pract 2019; 12:147-150. [DOI: 10.1213/xaa.0000000000000867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Horst K, Andruszkow H, Weber CD, Pishnamaz M, Knobe M, Bläsius FM, Lichte P, Lefering R, Hildebrand F. Surgical treatment strategies in pediatric trauma patients: ETC vs. DCO-an analysis of 316 pediatric trauma patients from the TraumaRegister DGU ®. Eur J Trauma Emerg Surg 2019; 45:801-808. [PMID: 30758537 DOI: 10.1007/s00068-019-01092-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/07/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE External fixation within the damage control concept in unstable multiple trauma patients is widely accepted. Literature about its usage in the pediatric trauma population, however, is rare. The aim of the present study was to elucidate the factors associated with the application of external fixation in the severely injured child. METHODS Patients with severe trauma aged 0-54 years documented in the TraumaRegister DGU® were included in this study. Demographic data, pattern of injury, injury severity, use of the damage control orthopedics (DCO) or early total care (ETC) concept, duration of mechanical ventilation, intensive care stay, and total hospital stay as well as the occurrence of complications and mortality were evaluated. Statistical evaluation was performed using SPSS (Version 21.0.0) using Chi square tests and linear regression models. RESULTS While injury severity was comparable between children and adults, type of accident and injury patterns showed significant differences, Overall, the majority of surgical fracture stabilization in AISExtremity ≥ 3 injuries followed the DCO concept in adults (60.3%) and the ETC protocol in children (49.4%). Conservative treatment was chosen for only 11.6% of all children and 9.6% of all adults. An increasing injury severity, AISExtremity ≥ 3 and AISExtremity ≥ 3 in ≥ 2 body regions, and a more advanced age were found to be independent factors in the use of the DCO concept in children. CONCLUSION Use of external fixation increases with age and plays a minor role in the very young trauma population. However, this does not produce a difference in outcome between children and adults.
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Affiliation(s)
- Klemens Horst
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany.
| | - Hagen Andruszkow
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Christian David Weber
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Miguel Pishnamaz
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Matthias Knobe
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Felix Marius Bläsius
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Philipp Lichte
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
| | - Rolf Lefering
- IFOM, Institute for Research in Operative Medicine, Faculty of Health, University Witten/Herdecke, Ostmerheimer Straße 200, 51109, Cologne, Germany
| | - Frank Hildebrand
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstreet 30, 52074, Aachen, Germany
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17
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Womack J, Pearson JD, Walker IA, Stephens NM, Goodman BA. Safety, complications and clinical outcome after ultrasound-guided paravertebral catheter insertion for rib fracture analgesia: a single-centre retrospective observational study. Anaesthesia 2019; 74:594-601. [PMID: 30687939 DOI: 10.1111/anae.14580] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 12/12/2022]
Abstract
Rib fractures are associated with significant morbidity and mortality. Ultrasound-guided thoracic paravertebral catheter insertion has been described for the management of pain secondary to rib fractures. We conducted a retrospective observational study of all patients with rib fractures who had a paravertebral catheter inserted for analgesia provision over a 4-year period. Data from the Trauma Audit and Research Network were used to compare patients with rib fractures who were managed with paravertebral catheters to those managed with systemic analgesia. A total of 314 consecutive paravertebral catheters were inserted in 290 patients. Five (1.9%) catheters were removed due to ineffective analgesia. Other minor complications occurred in three cases (0.96%). The proportion of rib fracture patients managed with paravertebral catheters increased from 31/200 (15.5%) in the first year of study to 81/168 (48.2%) in the fourth; over this time-period the observed:predicted mortality ratio fell from 1.04 to 0.66. Proportional hazard regression with and without propensity score matching demonstrated a reduction in mortality associated with paravertebral catheter use, but this became statistically non-significant when time-dependent analysis was used. Paravertebral catheters are a safe and effective technique for rib fracture analgesia; however, our data were insufficient to demonstrate any improvement in mortality.
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Affiliation(s)
- J Womack
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - J D Pearson
- James Cook University Hospital, Middlesbrough, UK
| | - I A Walker
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - N M Stephens
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - B A Goodman
- Royal Victoria Infirmary, Newcastle upon Tyne, UK.,School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
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18
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A Novel Approach to Identify Polytraumatized Patients in Extremis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7320158. [PMID: 29850559 PMCID: PMC5932503 DOI: 10.1155/2018/7320158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/11/2018] [Accepted: 02/27/2018] [Indexed: 12/01/2022]
Abstract
Introduction Due to the fact that early objective identification of polytraumatized patients in extremis is crucial for carrying out immediate life-saving measures, our objectives were to provide and scrutinize a definition that results in a particularly high mortality rate and to identify predictors of mortality in this group. Materials and Methods A polytraumatized patient (ISS ≥ 16) was classified “in extremis” if five out of seven parameters (arterial paCO2 > 50 mmHg, hemoglobin < 9.5 g/dl, pH value < 7.2, lactate level > 4 mmol/l, base excess < −6 mmol/l, shock index > 1, and Horowitz index < 300) were met. By applying this definition, polytraumatized patients (age ≥ 18 years), admitted to our level I trauma center within a time period of three years, were retrospectively allocated to the “in extremis” group and to an age-, gender-, and ISS-matched “non-in extremis” group for comparison. Results Out of 64 polytraumatized patients (mean ISS, 43.6), who formed the “in extremis” group, 36 patients (56.3%) died, thus revealing a threefold higher mortality rate than in the matched group (18.9%). Within the “in extremis” group, age and ISS were identified as predictors of mortality. Conclusion Our definition might serve as a valuable early warning score or at least an impetus for defining polytraumatized patients in extremis in clinical practice.
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19
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Berninger MT, Kellermann F, Woltmann A, Bühren V, Lang M. [Single-port VATS-assisted internal fixation of serial rib fractures]. Unfallchirurg 2018; 121:335-338. [PMID: 29500508 DOI: 10.1007/s00113-018-0471-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article describes the operative stabilization of a flail chest due to traumatic serial rib fractures with extensive chest wall deformation and respiratory insufficiency. Initial conservative treatment including systemic and regional pain management and non-invasive positive pressure ventilation did not improve the pain or ventilation. Therefore, a single-port video-assisted thoracoscopic surgery (VATS) assisted internal fixation of the ribs was performed. The thoracoscopy enabled easy repositioning of the ribs and additionally an estimation of intrathoracic injuries.
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Affiliation(s)
- M T Berninger
- BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland.
| | - F Kellermann
- BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland
| | - A Woltmann
- BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland
| | - V Bühren
- BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland
| | - M Lang
- BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland
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20
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Sharma S, Mishra B, Gupta A, Soni KD, Aggarwal R, Kumar S. Challenges in Management of Pediatric Life-threatening Neck and Chest Trauma. J Indian Assoc Pediatr Surg 2018; 23:10-15. [PMID: 29386758 PMCID: PMC5772087 DOI: 10.4103/jiaps.jiaps_49_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Neck and thoracic trauma in children pose unforeseen challenges requiring variable management strategies. Here, we describe some unusual cases. Patients and Methods: Pediatric cases of unusual neck and thoracic trauma prospectively managed from April 2012 to March 2014 at a Level 1 trauma center were studied for management strategies, outcome, and follow-up. Results: Six children with a median age of 5.5 (range 2–10) years were managed. Mechanism of injury was road traffic accident, fall from height and other accidental injury in 2, 3 and 1 patient respectively. The presentation was respiratory distress and quadriplegia, exposed heart, penetrating injury in neck, dysphagia and dyspnea, and swelling over the chest wall in 1, 1, 1, 2 and 1 cases respectively. Injuries included lung laceration, open chest wall, vascular injury of the neck, tracheoesophageal fistula (2), and chest wall posttraumatic pyomyositis. One patient had a flare of miliary tuberculosis. Immediate management included chest wall repair; neck exploration and repair, esophagostomy, gastroesophageal stapling, and feeding jejunostomy (followed by gastric pull-up 8 months later). Chest tube insertion and total parenteral nutrition was required in one each. 2 and 4 patients required tracheostomy and mechanical ventilation. The patient with gastric pull-up developed a stricture of the esophagogastric anastomosis that was revised at 26-month follow-up. At follow-up of 40–61 months, five patients are well. One patient with penetrating neck injury suffered from blindness due to massive hemorrhage from the vascular injury in the neck and brain ischemia with only peripheral vision recovery. Conclusion: Successful management of neck and chest wall trauma requires timely appropriate decisions with a team effort.
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Affiliation(s)
- Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Biplab Mishra
- Department of Trauma Surgery, JPN Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Department of Trauma Surgery, JPN Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Intensive and Critical Care, JPN Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department of Intensive and Critical Care, JPN Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Department of Trauma Surgery, JPN Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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21
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Verhoeff K, Mitchell JR. Cardiopulmonary physiology: why the heart and lungs are inextricably linked. ADVANCES IN PHYSIOLOGY EDUCATION 2017; 41:348-353. [PMID: 28679570 DOI: 10.1152/advan.00190.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/12/2017] [Accepted: 04/27/2017] [Indexed: 06/07/2023]
Abstract
Because the heart and lungs are confined within the thoracic cavity, understanding their interactions is integral for studying each system. Such interactions include changes in external constraint to the heart, blood volume redistribution (venous return), direct ventricular interaction (DVI), and left ventricular (LV) afterload. During mechanical ventilation, these interactions can be amplified and result in reduced cardiac output. For example, increased intrathoracic pressure associated with mechanical ventilation can increase external constraint and limit ventricular diastolic filling and, therefore, output. Similarly, high intrathoracic pressures can alter blood volume distribution and limit diastolic filling of both ventricles while concomitantly increasing pulmonary vascular resistance, leading to increased DVI, which may further limit LV filling. While LV afterload is generally considered to decrease with increased intrathoracic pressure, the question arises if the reduced LV afterload is primarily a consequence of a reduced LV preload. A thorough understanding of the interaction between the heart and lungs can be complicated but is essential for clinicians and health science students alike. In this teaching review, we have attempted to highlight the present understanding of certain salient aspects of cardiopulmonary physiology and pathophysiology, as well as provide a resource for multidisciplined health science educators and students.
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Affiliation(s)
- Kevin Verhoeff
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and
| | - Jamie R Mitchell
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
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22
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Claydon J, Maniatopoulos G, Robinson L, Fearon P. Challenges experienced during rehabilitation after traumatic multiple rib fractures: a qualitative study. Disabil Rehabil 2017; 40:2780-2789. [DOI: 10.1080/09638288.2017.1358771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jacqueline Claydon
- Major Trauma Rehabilitation Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Lisa Robinson
- Major Trauma Rehabilitation Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Paul Fearon
- Department of Trauma and Orthopaedics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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23
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Horst K, Simon TP, Pfeifer R, Teuben M, Almahmoud K, Zhi Q, Santos SA, Wembers CC, Leonhardt S, Heussen N, Störmann P, Auner B, Relja B, Marzi I, Haug AT, van Griensven M, Kalbitz M, Huber-Lang M, Tolba R, Reiss LK, Uhlig S, Marx G, Pape HC, Hildebrand F. Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma. Sci Rep 2016; 6:39659. [PMID: 28000769 PMCID: PMC5175194 DOI: 10.1038/srep39659] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/24/2016] [Indexed: 12/20/2022] Open
Abstract
Chest trauma has a significant relevance on outcome after severe trauma. Clinically, impaired lung function typically occurs within 72 hours after trauma. However, the underlying pathophysiological mechanisms are still not fully elucidated. Therefore, we aimed to establish an experimental long-term model to investigate physiological, morphologic and inflammatory changes, after severe trauma. Male pigs (sus scrofa) sustained severe trauma (including unilateral chest trauma, femur fracture, liver laceration and hemorrhagic shock). Additionally, non-injured animals served as sham controls. Chest trauma resulted in severe lung damage on both CT and histological analyses. Furthermore, severe inflammation with a systemic increase of IL-6 (p = 0.0305) and a local increase of IL-8 in BAL (p = 0.0009) was observed. The pO2/FiO2 ratio in trauma animals decreased over the observation period (p < 0.0001) but not in the sham group (p = 0.2967). Electrical Impedance Tomography (EIT) revealed differences between the traumatized and healthy lung (p < 0.0001). In conclusion, a clinically relevant, long-term model of blunt chest trauma with concomitant injuries has been developed. This reproducible model allows to examine local and systemic consequences of trauma and is valid for investigation of potential diagnostic or therapeutic options. In this context, EIT might represent a radiation-free method for bedside diagnostics.
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Affiliation(s)
- K Horst
- Department of Orthopaedic Trauma, RWTH Aachen University, Germany.,Harald Tscherne Research Laboratory, RWTH Aachen University, Germany
| | - T P Simon
- Department of Intensive Care and Intermediate Care, RWTH Aachen University, Germany
| | - R Pfeifer
- Department of Orthopaedic Trauma, RWTH Aachen University, Germany.,Harald Tscherne Research Laboratory, RWTH Aachen University, Germany
| | - M Teuben
- Department of Orthopaedic Trauma, RWTH Aachen University, Germany.,Harald Tscherne Research Laboratory, RWTH Aachen University, Germany
| | - K Almahmoud
- Department of Orthopaedic Trauma, RWTH Aachen University, Germany.,Harald Tscherne Research Laboratory, RWTH Aachen University, Germany
| | - Q Zhi
- Harald Tscherne Research Laboratory, RWTH Aachen University, Germany
| | - S Aguiar Santos
- Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - C Castelar Wembers
- Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - S Leonhardt
- Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - N Heussen
- Department of Medical Statistics, RWTH Aachen University, Germany.,Medical School, Sigmund Freud Private University, Vienna, Austria
| | - P Störmann
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Frankfurt/Main, Germany
| | - B Auner
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Frankfurt/Main, Germany
| | - B Relja
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Frankfurt/Main, Germany
| | - I Marzi
- Department of Trauma-, Hand- and Reconstructive Surgery, University of Frankfurt/Main, Germany
| | - A T Haug
- Experimental Trauma Surgery, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - M van Griensven
- Experimental Trauma Surgery, Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - M Kalbitz
- Department of Orthopedic Trauma, Hand-, Plastic-, and Reconstructive Surgery, University of Ulm, Germany
| | - M Huber-Lang
- Department of Orthopedic Trauma, Hand-, Plastic-, and Reconstructive Surgery, University of Ulm, Germany
| | - R Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Germany
| | - L K Reiss
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Germany
| | - S Uhlig
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Germany
| | - G Marx
- Department of Intensive Care and Intermediate Care, RWTH Aachen University, Germany
| | - H C Pape
- Department of Orthopaedic Trauma, RWTH Aachen University, Germany
| | - F Hildebrand
- Department of Orthopaedic Trauma, RWTH Aachen University, Germany
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24
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Almahmoud K, Teuben M, Andruszkow H, Horst K, Lefering R, Hildebrand F, Pape HC, Pfeifer R. Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®. Patient Saf Surg 2016; 10:24. [PMID: 27822309 PMCID: PMC5094000 DOI: 10.1186/s13037-016-0109-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/13/2016] [Indexed: 01/15/2023] Open
Abstract
Background Endotracheal intubation in severely injured patients is known to be a risk factor for systemic complications. We aimed to examine the changes in intubation rates and durations in severely injured trauma patients, and rates of the systemic complications associated with ventilation changes by using a large trauma registry over the period of 13 years. Methods Patient demographics, Injury Severity Score (ISS), ventilation days, ventilation free days (VFD), and prevalence of systemic complications (sepsis and multiple organ failure (MOF)) were obtained from the TraumaRegister DGU® and were compared over the study period. Results During the study period (2002 – 2014), 35,232 patients were recorded in TraumaRegister DGU®. 72.7 % of patients (n = 25,629) were intubated, and 27.3 % (n = 9603) of patients did not require mechanical ventilation throughout their hospital stay. The mean age was 48 ± 21 years, mean ISS was 27.9 ± 11.5, mean length of ICU stay was 11.7 ± 13.8 days, mean time on mechanical ventilator was 7.1 ± 11.3 days, and mean ventilation free days (spontaneous respiration) was 19.5 ± 11.9 days. We observed a reduction in the intubation rates (87.5 % in 2002 versus 63.6 % in 2014), and early extubation (10 ventilation days in 2002, and 5.9 days in 2014) over time. Conclusion Our study reveals a reduction in intubation rates and ventilation duration during the observation period. Moreover, we were able to observe decreased incidence of systemic complications such as sepsis over the 13 year study period, while no changes in incidence of MOF were registered. The exact relationship can not be proven in our study. This needs to be addressed in further analysis.
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Affiliation(s)
- Khalid Almahmoud
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Michel Teuben
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Hagen Andruszkow
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Klemens Horst
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, 51109 Cologne, Germany
| | - Frank Hildebrand
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Hans Christoph Pape
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
| | - Roman Pfeifer
- Department of Orthopedics Trauma Surgery, University of Aachen Medical Center, 52074 Aachen, Germany ; Harald Tscherne Laboratory, RWTH Aachen University, 52074 Aachen, Germany
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25
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Pandharikar N, Sachdev A, Gupta N, Gupta S, Gupta D. Chest trauma: A case for single lung ventilation. Indian J Crit Care Med 2016; 20:248-50. [PMID: 27303142 PMCID: PMC4906333 DOI: 10.4103/0972-5229.180050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Chest trauma is one of the important causes of mortality and morbidity in pediatric trauma patients. The complexity, magnitude, and type of lung injury make it extremely challenging to provide optimal oxygenation and ventilation while protecting the lung from further injury due to mechanical ventilation. Independent lung ventilation is used sporadically in these patients who do not respond to these conventional ventilatory strategies using double-lumen endotracheal tubes, bronchial blocker balloons, etc. However, this equipment may not be easily available in developing countries, especially for pediatric patients. Here, we present a case of severe chest trauma with pulmonary contusion, flail chest, and bronchopleural fistula, who did not respond to conventional lung protective strategies. She was successfully managed with bronchoscopy-guided unilateral placement of conventional endotracheal tube followed by single lung ventilation leading to resolution of a chest injury.
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Affiliation(s)
- Nagaraj Pandharikar
- Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Sachdev
- Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Neeraj Gupta
- Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Suresh Gupta
- Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Dhiren Gupta
- Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
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26
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Qi Y. Clinical study on VATS combined mechanical ventilation treatment of ARDS secondary to severe chest trauma. Exp Ther Med 2016; 12:1034-1038. [PMID: 27446317 PMCID: PMC4950469 DOI: 10.3892/etm.2016.3355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/17/2016] [Indexed: 12/25/2022] Open
Abstract
The aim of the study was to investigate the clinical effects of microinvasive video-assisted thoracoscopic surgery (VATS) combined with mechanical ventilation in the treatment of acute respiratory distress syndrome (ARDS) secondary to severe chest trauma. A total of 62 patients with ARDS secondary to severe chest trauma were divided into the observation and control groups. The patients in the observation groups were treated with VATS combined with early mechanical ventilation while patients in the control group were treated using routine open thoracotomy combined with early mechanical ventilation. Compared to the controls, the survival rate of the observation group was significantly higher. The average operation time of the observation group was significantly shorter than that of the control group, and the incidence of complications in the perioperative period of the observation group was significantly lower than that of the control group (p<0.05). The average application time of the observation group was significantly shorter than that of the control group, and the incidence of ventilator-associated complications was significantly lower than that of the control group (p<0.05). In conclusion, a reasonable understanding of the indications and contraindications of VATS, combined with early mechanical treatment significantly improved the success rate of the treatment of ARDS patients secondary to severe chest trauma and reduced the complications.
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Affiliation(s)
- Yongjun Qi
- Department of Thoracic Surgery, Beijing Mentougou Hospital, Beijing 102300, P.R. China
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Alisha C, Gajanan G, Jyothi H. Risk Factors Affecting the Prognosis in Patients with Pulmonary Contusion Following Chest Trauma. J Clin Diagn Res 2015; 9:OC17-9. [PMID: 26435984 DOI: 10.7860/jcdr/2015/13285.6375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 06/12/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Thoracic injury and its complications are responsible for as much as 25% for blunt trauma mortality. Pulmonary contusion occurs in 30%-75% of these cases. Despite advances in pulmonary care and intensive care management pulmonary contusion still contributes to higher mortality and morbidity for patients with severe injuries. AIM To assess the outcome of pulmonary contusions in patients with chest trauma and various factors determining mortality in these patients. MATERIALS AND METHODS A retrospective case study, over a period of one year, of all chest trauma cases with pulmonary contusions confirmed by X-rays or CT scan of thorax, were included in the study. All the cases were assessed for age, associated injuries, APACHE II score, SAPS II score, SOFA score, paO2/Fio2 ratio, fracture of ribs, presence of haemothorax or pneumothorax, ventilator and ICU days and finally hospital outcome. RESULTS A total of 16 cases of pulmonary contusions were included in the study. Five patients died during the ICU stay and 11 survived. All patients had associated injuries. There was significant difference seen in APACHE II score (p<0.001), SAPS II score (p<0.001), SOFA score (p<0.001), paO2/Fio2 ratio (p<0.022) and ventilator days (p<0.001) among the survivors and non-survivors. However, no significant difference was seen in presence of fracture of ribs and presence of either haemothorax or pneumothorax. CONCLUSION The risk factors that were associated with higher mortality in patients with pulmonary contusions following chest trauma were APACHE II score, SAPS II score, SOFA score, paO2/Fio2 ratio and ventilator days. Close monitoring to improve the gas exchange and better fluid management will help in improving the survival in these patients.
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Affiliation(s)
- Chaudhury Alisha
- Senior Resident, Department of Pulmonary Medicine, KLE University's J. N. Medical College , Belgaum, India
| | - Gaude Gajanan
- Professor and Head, Department of Pulmonary Medicine, KLE University's J. N. Medical College , Belgaum, India
| | - Hattiholi Jyothi
- Assistant Professor, Department of Pulmonary Medicine, KLE University's J. N. Medical College , Belgaum, India
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Radomski M, Zettervall S, Schroeder ME, Messing J, Dunne J, Sarani B. Critical Care for the Patient With Multiple Trauma. J Intensive Care Med 2015; 31:307-18. [PMID: 25673631 DOI: 10.1177/0885066615571895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023]
Abstract
Trauma remains the leading cause of death worldwide and the leading cause of death in those less than 44 years old in the United States. Admission to a verified trauma center has been shown to decrease mortality following a major injury. This decrease in mortality has been a direct result of improvements in the initial evaluation and resuscitation from injury as well as continued advances in critical care. As such, it is vital that intensive care practitioners be familiar with various types of injuries and their associated treatment strategies as well as their potential complications in order to minimize the morbidity and mortality frequently seen in this patient population.
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Affiliation(s)
- Michal Radomski
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - Sara Zettervall
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - Mary Elizabeth Schroeder
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - Jonathan Messing
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - James Dunne
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - Babak Sarani
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
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29
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Lee DK, Lim SH, Lim BG, Kang SW, Kim H. Management of traumatic pneumothorax with massive air leakage: role of a bronchial blocker: a case report. Korean J Anesthesiol 2014; 67:354-7. [PMID: 25473467 PMCID: PMC4252350 DOI: 10.4097/kjae.2014.67.5.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/18/2014] [Accepted: 04/28/2014] [Indexed: 11/10/2022] Open
Abstract
Massive air leakage through a lacerated lung produces inadequate ventilation and hypoxemia. Tube exchange from a single to double lumen endotracheal tube (DLT), and lung separation to maintain oxygenation, are challenging for seriously injured patients. In this case report, we aim to describe how a bronchial blocker (BB) makes it easier to perform a lung separation in this situation; it also increases the overall safety of the procedure. A 35-year-old female (163 cm, 47 kg) suffered from blunt chest trauma due to a traffic accident; the accident caused right-sided lung laceration with massive air leakage. Paradoxically, positive ventilation worsened SaO2 and leakage increased through a chest tube. We introduced BB while the patient was still awake: Left-side one-lung ventilation (OLV) was established and anesthesia was induced. After PaO2 was maximized with OLV, we changed the endotracheal tube to DLT without a hypoxic event. By BB placement, we maintained PaO2 at a secure level, conducted mechanical ventilation and exchanged the tube without deterioration.
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Affiliation(s)
- Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Sang Ho Lim
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Byung Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Sung Wook Kang
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Heezoo Kim
- Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
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30
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Razi E. Mechanical ventilation in chest trauma. ARCHIVES OF TRAUMA RESEARCH 2014; 3:e25446. [PMID: 25821753 PMCID: PMC4360598 DOI: 10.5812/atr.25446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/24/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Ebrahim Razi
- Trauma Research Center, Shahid-Beheshti Hospital, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Ebrahim Razi, Trauma Research Center, Shahid-Beheshti Hospital, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155620634, E-mail: .
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31
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Sian K, McAllister B, Brady P. The use of extracorporeal membrane oxygenation therapy in the delayed surgical repair of a tracheal injury. Ann Thorac Surg 2014; 97:338-40. [PMID: 24384192 DOI: 10.1016/j.athoracsur.2013.04.126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 03/20/2013] [Accepted: 04/22/2013] [Indexed: 01/19/2023]
Abstract
Acute tracheal injury secondary to intubation can present with varying degrees of severity. Onset of symptoms occur hours or even days after the initial injury. A 34-year-old woman required surgery for a large tracheal tear after emergency intubation. The inability to adequately ventilate combined with secondary aspiration injury required that the patient be placed on extracorporeal membrane oxygenation before undergoing surgery. This case demonstrates the use of extracorporeal membrane oxygenation to manage a patient awaiting surgery for severe tracheal tears.
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Affiliation(s)
- Karan Sian
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
| | - Brylie McAllister
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Peter Brady
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia
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32
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Arora S, Singh PM, Trikha A. Ventilatory strategies in trauma patients. J Emerg Trauma Shock 2014; 7:25-31. [PMID: 24550626 PMCID: PMC3912646 DOI: 10.4103/0974-2700.125635] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/02/2013] [Indexed: 01/21/2023] Open
Abstract
Lung injury in trauma patients can occur because of direct injury to lung or due to secondary effects of injury elsewhere for example fat embolism from a long bone fracture, or due to response to a systemic insult such as; acute respiratory distress syndrome (ARDS) secondary to sepsis or transfusion related lung injury. There are certain special situations like head injury where the primary culprit is not the lung, but the brain and the ventilator strategy is aimed at preserving the brain tissue and the respiratory system takes a second place. The present article aims to delineate the strategies addressing practical problems and challenges faced by intensivists dealing with trauma patients with or without healthy lungs. The lung protective strategies along with newer trends in ventilation are discussed. Ventilatory management for specific organ system trauma are highlighted and their physiological base is presented.
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Affiliation(s)
- Shubhangi Arora
- Department of Anaesthesia, All India Institute of Medical Sciences, Delhi, India
| | - Preet Mohinder Singh
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjan Trikha
- Department of Anaesthesia, All India Institute of Medical Sciences, Delhi, India
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Abstract
Blunt chest wall trauma accounts for a large proportion of all trauma presentations to the Emergency Departments in the United Kingdom and has a high reported incidence of morbidity and mortality. The difficulty in the assessment and management of this patient group arises from the possibility that the patient may develop potentially life-threatening complications up to approximately 72 h post-injury, even in patients who have sustained what is initially considered a minor injury. Limited consensus currently exists in the literature regarding optimal assessment or management strategies for this patient group. The aim of this review is to provide an overview of current research investigating the optimal assessment and management strategies for the blunt chest wall trauma patient.
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Affiliation(s)
- Ceri Battle
- Physiotherapy Department, Morriston Hospital, Swansea, UK
- College of Medicine, Swansea University, Swansea, UK
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