Early Management of Retained Hemothorax in Blunt Head and Chest Trauma

Abstract

BackgroundMajor blunt chest injury usually leads to the development of retained hemothorax and pneumothorax, and needs further intervention. However, since blunt chest injury may be combined with blunt head injury that typically requires patient observation for 3–4 days, other critical surgical interventions may be delayed. The purpose of this study is to analyze the outcomes of head injury patients who received early, versus delayed thoracic surgeries.Materials and methodsFrom May 2005 to February 2012, 61 patients with major blunt injuries to the chest and head were prospectively enrolled. These patients had an intracranial hemorrhage without indications of craniotomy. All the patients received video-assisted thoracoscopic surgery (VATS) due to retained hemothorax or pneumothorax. Patients were divided into two groups according to the time from trauma to operation, this being within 4 days for Group 1 and more than 4 days for Group 2. The clinical outcomes included hospital length of stay (LOS), intensive care unit (ICU) LOS, infection rates, and the time period of ventilator use and chest tube intubation.ResultAll demographics, including age, gender, and trauma severity between the two groups showed no statistical differences. The average time from trauma to operation was 5.8 days. The ventilator usage period, the hospital and ICU length of stay were longer in Group 2 (6.77 vs. 18.55, p = 0.016; 20.63 vs. 35.13, p = 0.003; 8.97 vs. 17.65, p = 0.035). The rates of positive microbial cultures in pleural effusion collected during VATS were higher in Group 2 (6.7 vs. 29.0%, p = 0.043). The Glasgow Coma Scale score for all patients improved when patients were discharged (11.74 vs. 14.10, p < 0.05).DiscussionIn this study, early VATS could be performed safely in brain hemorrhage patients without indication of surgical decompression. The clinical outcomes were much better in patients receiving early intervention within 4 days after trauma.

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].…”

Kết Quả Điều Trị Chấn Thương Ngực Kèm Theo Chấn Thương Sọ Não Có Dẫn Lưu Màng Phổi Đơn Thuần Tại Bệnh Viện Hữu Nghị Việt Đức

“…Chấn thương ngực (CTN) là một cấp cứu ngoại khoa thường gặp ở các bệnh viện lớn của tỉnh và thành phố, chiếm khoảng 7-10% cấp cứu ngoại khoa 1,2 . Chấn thương ngực là thương tích phổ biến thứ ba ở bệnh nhân chấn thương, sau chấn thương đầu và tứ chi, tỷ lệ tử vong là 10,8%.…”

Traumatic retained hemothorax: is it time for video assisted thoracoscopic surgery

“…27 In case of patients with head trauma, not severe to require a craniotomy, associated with thoracic injury, it was found that VATS can be performed effectively and safely with the advantage of shorter hospital stay and lesser infection when done within 4 days of trauma. 28 Thus, earlier the VATS, better is the success rate of evacuation and shorter is the hospital stay.…”