Blunt Traumatic Occult Pneumothorax: Is Observation Safe?—Results of a Prospective, AAST Multicenter Study

Moore, Forrest O.; Goslar, Pamela W.; Coimbra, Raúl; Velmahos, George C.; Brown, Carlos; Coopwood, Thomas B.; Lottenberg, Lawrence; Phelan, Herbert; Bruns, Brandon R.; Sherck, John P.; Norwood, Scott H.; Barnes, Stephen L.; Matthews, Marc R.; Hoff, William S.; Moya, Marc A. de; Bansal, Vishal; Hu, Charles; Karmy‐Jones, Riyad; Vinces, Fausto; Pembaur, Karl; Notrica, David M.; Haan, James M.

doi:10.1097/ta.0b013e318213f727

Cited by 100 publications

(113 citation statements)

References 15 publications

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“…Definimos el tratamiento como exitoso o fallido; si el neumotórax creció o hubo algún deterioro fisiológico del paciente que finalmente requirió el uso de sonda pleural, fue considerado como fallido. [1][2][3] Research Assistant, [4][5][6] Assistant Professor, 7 Professor 8 Associate Professor [1][2][3][4][5][6][7][8] Department of Surgery, Massachusetts General Hospital Boston, MA, USA Resultados: De un total de 165 pacientes con neumotórax, 17 (10.3%) midieron >35 mm y 148 (89.7%) midieron <35 mm. De los 17 >35 mm, 15 (88.7%) fueron tratados inmediatamente con sonda pleural.…”

Section: Materiales Y Métodosunclassified

“…4 An increasing body of literature supports observation in stable patients as an acceptable alternative to TT, with failure of observation rates approaching 6%. 5 Based on previous work, 6 we sought to explore if a PTX measuring ≤ 35 mm in patients who have no physiologic derangement may be safely observed without TT regardless of the need for positive pressure ventilation.…”

Section: Introductionmentioning

confidence: 99%

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Pneumothoraces on Computed Tomography Scan: Observation using the 35 Millimeter Rule is Safe

Cropano¹,

Mesar²,

Turay³

et al. 2015

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Introduction:The management of a pneumothorax (PTX) either by observation or with a tube thoracostomy (TT) has long been dictated by practitioner discretion rather than objective criteria. Many physicians elect to routinely place a TT for traumatic PTX, particularly when patients undergo positive pressure ventilation (PPV). Placement of unnecessary TT exposes patients to avoidable morbidity and may prolong hospitalization. Based on prior work establishing a cutoff, we hypothesized that all PTXs ≤ 35 mm in patients who have no physiologic derangement may be safely observed without TT regardless of the need for PPV. Materials and methods:Retrospective review of all patients diagnosed with a PTX between 1/2009 and 2/2013. All PTXs visible on chest computed tomography (CT) were identified. Any patient with an associated significant hemothorax or those patients who were moribund were excluded. All PTXs were measured by measuring the perpendicular distance of the largest air pocket between the chest wall and the mediastinal or pulmonary structure. Management of the PTX was categorized as observation or TT. Observed PTXs were labeled as success or failure with failure defined as enlargement of the PTX or physiologic deterioration, requiring a TT.Results: Out of 165 PTXs, 17 (10.3%) measured >35 mm, whereas 148 (89.7%) measured ≤35 mm. Of the 17 > 35 mm, 15 (88.2%) received immediate TT. Of the two PTXs >35 mm which were observed, one received a delayed TT for a pleural effusion (6 days after PTX diagnosis) and one (5.9 %) was safely observed. Of the 148 PTXs which measured ≤ 35 mm, 10 (6.8%) received immediate TT. Of the 138 remaining PTXs, 129 (93.5%) were safely managed without TT. Six (4.3%) of the PTXs initially observed eventually required TT placement for enlargement of the PTX. Only one of those six had manifested ongoing desaturations prior to TT. The remaining three cases received TT for reasons unrelated to the PTX. Of the 27 PPV cases in the ≤35 mm cohort, none contributed to the six failures. A cutoff measurement of 35 mm demonstrated a negative predictive value (NPV) of 95.7% in its ability to predict successful observation of the PTX with an area under the receiver operating characteristic (ROC) curve of 0.90. Conclusion:All PTXs measuring ≤35 mm perpendicular to the chest wall without physiologic derangement may be safely observed independent of the need for mechanical ventilation. Source of support: Nil Conflict of interest: None RESUMENIntroducción: El manejo del neumotórax, ya sea con observación clínica o con sonda pleural, se ha basado en el juicio clínico y no en criterios objetivos.

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Section: Materiales Y Métodosunclassified

Section: Introductionmentioning

confidence: 99%

Pneumothoraces on Computed Tomography Scan: Observation using the 35 Millimeter Rule is Safe

Cropano¹,

Mesar²,

Turay³

et al. 2015

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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“…среди причин, затрудняющих широкое рас-пространение данного направления в США, назы-вают отсутствие специализированной подготовки у ургентных хирургов, большой поток пострадавших в центрах травмы, недостаточное финансирование [54]. Тем не менее многие авторы указывают на не-обходимость частичного пересмотра хирургической тактики и введение торакоскопии в стандарты ока-зания помощи пострадавшим с торакальной трав-мой [36,53,58,65].…”

Section: заключениеunclassified

Thoracoscopy for chest trauma

Панкратов¹,

Khatkov²,

Izrailov³

et al. 2015

Endosk. khir.

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“…In this regard, according to some authors, the use of video endoscopic technique is very promising for qualitatively new way to solve the problem of treatment of patients in this category (Jestkov et al, 2002;Ahmed and Jones, 2004;Korotkov, Kutirev and Kukushkin, 2006;Krotov et al, 2009;Moore et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

The Abilities of Videothoracoscopy at Blunt Thoracic Traumas

Каримов¹,

Беркинов²,

Fayzullaev³

2015

Adv. Sci.

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Abstract. Overall 292 patients with the blunt trauma of the chest were at the in-patient treatment from 2006 to 2011 years at the 2 nd clinic of the Tashkent Medical Academy. All the patients were separated by us to 2 groups: the first (control) group are 145 (49,7%) patients, who were diagnosed and treated without using of the videothoracoscopy; the second (basic) group are 147 patients, at whom the videothoracoscopy was used at the stages of diagnostic and treatment. As a result of performed research was confirmed that using of the videothoracoscopy at the patients with the blunt thoracic trauma helps to reduce the number of the postoperative complications from 23.4% to 14,3% of the cases, allows to reduce the frequency of the wide thoracotomy from 11,7% to 0,6% of the cases, reduce the terms of being of the patients at the stationer.

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Blunt Traumatic Occult Pneumothorax: Is Observation Safe?—Results of a Prospective, AAST Multicenter Study

Abstract: Most blunt trauma patients with OPTX can be carefully monitored without tube thoracostomy; however, OPTX progression and respiratory distress are independently associated with observation failure.

Cited by 100 publications

References 15 publications

Pneumothoraces on Computed Tomography Scan: Observation using the 35 Millimeter Rule is Safe

Pneumothoraces on Computed Tomography Scan: Observation using the 35 Millimeter Rule is Safe

Thoracoscopy for chest trauma

The Abilities of Videothoracoscopy at Blunt Thoracic Traumas

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