Early and Persistent Hemothorax and Pneumothorax

Abstract

The incidence of traumatic injury to the thorax is estimated at up to 40 % of patients that require hospitalization. The vast majority of these injuries can be managed with observation. However, the presence of pneumothorax or hemothorax has traditionally mandated tube thoracostomy placement and the inherent morbidities that may arise. Persistent pneumothorax is typically defined as the presence of pneumothorax and/or air leak for 5-7 days after tube placement. This morbidity may be managed expectantly or with video-assisted thoracoscopic surgery (VATS). The most feared complication after hemothorax is the presence of retained blood and the risk of infection that follows. Most authorities support the early use of VATS to resolve retained hemothoraces with the hopes of avoiding more invasive procedures aimed at the treatment of fibrothorax and empyema.

Effectiveness and safety of small-bore tube thoracostomy (≤20 Fr) for chest trauma patients: A retrospective observational study

“…In cases of traumatic pneumothorax, although there are no established surgical indications, continuous air leakage for >5 days is generally accepted to be an indication for VATS. [7] In our study, depending on the judgment of the thoracic surgeon, VATS was generally performed as a definitive treatment a few days after a chest injury occurred. A patient who had self-extracted a chest tube due to alcohol withdrawal-induced delirium underwent VATS on the second day, but the drainage itself went well.…”

Facilitating ventilator weaning through rib fixation combined with video-assisted thoracoscopic surgery in severe blunt chest injury with acute respiratory failure

“…Other studies have usually targeted treatments of severe blunt chest trauma by managing the hemothorax or pneumothorax [21][22][23]. Initially, fractured ribs were not the main target of treatment in our hospital [23].…”