CT-lung volume estimates in trauma patients undergoing stabilizing surgery for flail chest

Caragounis, Eva-Corina; Olsén, Monika Fagevik; Granhed, Hans; Norrlund, Rauni Rossi

doi:10.1016/j.injury.2018.10.016

Cited by 10 publications

(16 citation statements)

References 27 publications

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“…However, in the case of suspected COPD, it was shown to be a significant variable for FEV1 and VC recovery. Aside from using these physiological indices, a previous study attempted to measure lung function recovery by measuring lung volume via the application of a rendering technique to chest CTs (Caragounis et al, 2019). In a study on lung function recovery based on periodic testing of pulmonary function, Caragounis et al (2016) conducted a 1-year follow-up of patients who underwent rib fixation and reported that FVC and FEV1 improved significantly at 6-and 12-month postoperation.…”

Section: Discussionmentioning

confidence: 99%

When will pulmonary function recover after rib fracture?

Hwang

Lee

2020

J Exerc Rehabil

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Rib fracture is almost recovered with conservative management including oral medication. Pain is easily controlled with medication, but physiologic function is not readily evaluated. This study is aimed to investigate the factors influencing to recovery of pulmonary function test (PFT) and changes according to times after rib fracture. From August 2015 to January 2018, medical records of patients with rib fracture were reviewed retrospectively. Factors may influencing to recovery of PFT (age, chronic obstructive pulmonary disease, numbers of fractures, intercostal nerve block) were evaluated, and serial (initial, 1 month, 2 months) changes of parameters PFT (forced vital capacity [FVC], forced expiratory volume in 1 sec [FEV1], total lung capacity [TLC], vital capacity [VC]) for 2 months were observed. Total patients were 60, and PFT was completed 38 and 27 patients after 1 month and 2 months respectively. Mean age was 55.1 years (20-84 years) and mean numbers of fracture were 3.98 (1-11). Intercostal nerve block and rib fixation were performed in 32 cases and 2 cases respectively. Age, numbers of fracture and intercostal nerve block were not significant factors to changes of PFT. But chronic obstructive pulmonary disease was significant factor to recovery of FEV1 in 1 month. PFT was improved in FVC, FEV1 through 2 months, and improved in TLC, VC in 1 month. This study showed the evidence and prognosis of physiologic recovery after rib fracture. And we could tell about physiologic recovery to rib fracture patients with this study.

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Section: Discussionmentioning

confidence: 99%

When will pulmonary function recover after rib fracture?

Hwang

Lee

2020

J Exerc Rehabil

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“…This is very challenging in terms of methodology. In this respect, one of the major studies evaluating the effect of rib fixation on pulmonary function test was performed by Caragouinis et al [29,30] They evaluated lung volume from preoperative and postoperative computed tomography images and compared the results with postoperative pulmonary function tests. In the early period in which the cases were intubated, there was no significant difference in the FVC and total lung capacity.…”

Section: Discussionmentioning

confidence: 99%

The benefits of early rib fixation for clinical outcomes of flail chest patients in intensive care unit

Ağababaoğlu

Ersöz

2020

Turk Gogus Kalp Dama

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Bu çalışmada yelken göğüs hastalarında konservatif ve cerrahi stabilizasyon yaklaşımlarının klinik sonuçları karşılaştırıldı ve erken redüksiyonun etkisi araştırıldı. Ça lış m a pla nı: Mart 2013-Aralık 2017 tarihleri arasında erken kaburga fiksasyonu yapılan yelken göğüslü 34 hasta (23 erkek, 11 kadın; ort. yaş 43.7±12.1 yıl; dağılım 20-74 yıl) cerrahi grubuna ve Şubat 2012-Aralık 2017 tarihleri arasında konservatif yaklaşım ile takip edilen yelken göğüslü 29 hasta (19 erkek, 10 kadın; ort. yaş 45.7±15.8 yıl; dağılım 24-74 yıl) konservatif tedavi grubuna alındı. Travmanın olduğu gün veya bir sonraki gün (24 ila 36 saat içerisinde) erken kaburga redüksiyonu uygulandı. Hastanede kalış süresi, ameliyat sonrası dönemde pnömoni ve septik komplikasyon varlığı, mortalite, mekanik ventilasyon süresi, trakeostomi oranı, solunum fonksiyon test sonuçları ve ağrı skorları kaydedildi ve gruplar arasında karşılaştırıldı. Bul gu lar: Hastanede ve yoğun bakım ünitesinde yatış süresi ve mekanik ventilasyon süresi cerrahi grubuna kıyasla, konservatif tedavi grubunda istatistiksel olarak anlamlı düzeyde daha uzun idi (sırasıyla p<0.001, p<0.001 ve p<0.001). Cerrahi grupta hiçbir hastada trakeostomi gerekmez iken, konservatif tedavi grubunda beş hastada trakeostomi gereksinimi oldu (p= 0.004). Mortalite oranları cerrahi ve konservatif tedavi gruplarında sırasıyla %2.94 ve %20.69 idi (p= 0.027). Ağrı skorları, konservatif tedavi grubuna kıyasla, cerrahi grup lehine istatistiksel olarak anlamlı düzeyde farklı idi (sırasıyla p= 0.0038 ve p= 0.044). So nuç:Çalışmamızın sonuçları erken fiksasyon ve erken ekstübasyonun mekanik ventilasyon gereksinimini, hastanede yatış süresini, trakeostomi ihtiyacını ve ölüm oranlarını azalttığını göstermektedir. Bu yaklaşım, yelken göğüs hastalarında uzun dönem ağrı şikayetinde ve solunum fonksiyon testlerinde önemli bir iyileşme sağlar. Anah tarsöz cük ler: Yelken göğüs, kilitli kaburga plağı, kaburga kırığı, toraks travması.

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“…Literature is now compounding to demonstrate the benefits of rib fixation including decreased rates of pneumonia, decreased mechanical ventilation times, shorter lengths of hospital stay, as well as decreases in mortality compared to mechanical ventilation alone (Leinicke et al, n.d.;Beks et al, 2019;Cataneo et al, 2015;Coughlin et al, 2016;Fowler et al, 2014;Ingoe et al, 2019;Kocher et al, 2017;Kyriss et al, 2016;Liu et al, 2019;Marasco et al, 2013;Schuurmans et al, 2017;Swart et al, 2017;Taylor et al, 2016). These benefits are supported by several studies demonstrating the significant improvements in pulmonary function tests post-operatively compared to pre-operatively (Caragounis et al, 2019;Slobogean et al, 2015;Sm et al, 2014). It is thought that by restoring the anatomic relationship of the ribs in a flail chest segment that improved rib biomechanics and respiratory function may be restored (Grupp et al, 2017;Leinicke et al, 2013;Swart et al, 2017).…”

Section: Introductionmentioning

confidence: 98%

“…Flail chest injuries, defined as three or more consecutive, segmental rib fractures are among the most significant of these patterns (Davignon et al, 2004;Vana et al, 2014;Vyhnanek et al, 2011). This allows for the rib segment which is no longer in contact with the remainder of the chest wall to move inwards upon inspiration paradoxically, which limits intrathoracic expansion and decreases lung volumes (Caragounis et al, 2019;Davignon et al, 2004;Slobogean et al, 2015). Mortality in patients with flail chest injuries has been described as being as high as 15-33%, with risk of death much higher in the acute injury period (Cannon et al, 2012;Caragounis et al, 2019;Dehghan et al, 2014;Fowler et al, 2014;Zehr et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…This allows for the rib segment which is no longer in contact with the remainder of the chest wall to move inwards upon inspiration paradoxically, which limits intrathoracic expansion and decreases lung volumes (Caragounis et al, 2019;Davignon et al, 2004;Slobogean et al, 2015). Mortality in patients with flail chest injuries has been described as being as high as 15-33%, with risk of death much higher in the acute injury period (Cannon et al, 2012;Caragounis et al, 2019;Dehghan et al, 2014;Fowler et al, 2014;Zehr et al, 2015). Several factors have been shown to influence injury severity and mortality including number of involved ribs, location of rib fractures, concomitant pulmonary contusion, and effect on intrathoracic pressures (Davignon et al, 2004;Vyhnanek et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

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A model for evaluating the biomechanics of rib fracture fixation

Myers

McGowan

Taylor

et al. 2020

Clinical Biomechanics

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High rates of morbidity and mortality following flail chest rib fractures are well publicized. Standard of care has been supportive mechanical ventilation, but serious complications have been reported. Internal rib fixation has shown improvements in pulmonary function, clinical outcomes, and decreased mortality. The goal of this study was to provide a model defining the biomechanical benefits of internal rib fixation. Methods: One human cadaver was prepared with an actuator providing anteroposterior forces to the thorax and rib motion sensors to define interfragmentary motion. Cadaveric model was validated using a prior study which defined costovertebral motion to create a protocol using similar technology and procedure. Ribs 4-6 were fixed with motion sensors anteriorly, laterally and posteriorly. Motion was recorded with ribs intact before osteotomizing each rib anteriorly and laterally. Flail chest motion was record with fractures subsequently plated and analyzed. Motion was recorded in the sagittal, coronal and transverse axes. Findings: Compared to the intact rib model, the flail chest model demonstrated an 11.3 times increase in sagittal plane motion, which was reduced to 2.1 times the intact model with rib plating. Coronal and sagittal plane models also saw increases of 9.7 and 5.1 times, respectively, with regards to flail chest motion. Both were reduced to 1.2 times the intact model after rib plating. Interpretation: This study allows quantification of altered ribcage biomechanics after flail chest injuries and suggests rib plating is useful in restoring biomechanics as well as contributing to improving pulmonary function and clinical outcomes.

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CT-lung volume estimates in trauma patients undergoing stabilizing surgery for flail chest

Abstract: Avhandlingen baseras på följande delarbeten I.Mechanism of injury, injury patterns and associated injuries in patients operated for chest wall trauma. Caragounis E-C, Xiao Y och Granhed H.

Cited by 10 publications

References 27 publications

When will pulmonary function recover after rib fracture?

When will pulmonary function recover after rib fracture?

The benefits of early rib fixation for clinical outcomes of flail chest patients in intensive care unit

A model for evaluating the biomechanics of rib fracture fixation

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