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

Abstract

Background: Severe blunt chest injury sometimes induces acute respiratory failure (ARF), requiring ventilator use. We aimed to evaluate the effect of performing rib fixation with the addition of video-assisted thoracoscopic surgery (VATS) on patients with ARF caused by blunt thoracic injury with ventilator dependence.Methods: This observational study prospectively enrolled patients with multiple bicortical rib fractures with hemothorax caused by severe blunt chest trauma. All patients received positive pressure mechanical ventilation within 24 h after trauma because of ARF. Some patients who received rib fixation with VATS were enrolled as group 1, and the others who received only VATS were designated as group 2. The length of ventilator use was the primary clinical outcome. Rates of pneumonia and length of hospital stay constituted secondary outcomes.Results: A total of 61 patients were included in this study. The basic demographic characteristics between the two groups exhibited no statistical differences. All patients received operations within 6 days after trauma. The length of ventilator use was shorter in group 1 (3.19 ± 3.37 days vs. 8.05 ± 8.23, P = 0.002). The rate of pneumonia was higher in group 2 (38.1% vs. 75.0%, P = 0.005). The length of hospital stay was much shorter in group 1 (17.76 ± 8.38 days vs. 24.13 ± 9.80, P = 0.011). Conclusion: Rib fixation combined with VATS could shorten the length of ventilator use and reduce the pneumonia rate in patients with severe chest blunt injury with ARF. Therefore, this operation could shorten the overall length of hospital stay.

It is Time to Replace Large Drains with Small Ones After Fixation of Rib Fractures: A Prospective Observational Study

“…One of the main goals after SSRF is pain reduction. In our previous study, SSRF dramatically reduced pain [ 15 , 16 ], and the analgesic dose was significantly reduced compared with patients who did not undergo SSRF. In this study, because all patients underwent SSRF, the analgesic dose was similar between both groups.…”

“…Surgical fixation was indicated for total displacement of fractured ribs. In our hospital, VATS is performed simultaneously with SSRF [ 15 , 16 ], and both procedures are arranged within days after trauma. General anesthesia with single-lung ventilation is also required during the operation.…”

Management Pathways for Traumatic Rib Fractures—Importance of Surgical Stabilisation

“…This study also revealed that conducting SSRF in flail chest patients improved forced vital capacity (FVC), lung function, and cost-effectiveness; and ensured the quicker return of patients to fulltime work [ 32 ]. A 2020 observational study by Wu et al showed that ventilator-dependent patients with acute respiratory failure after severe blunt chest injury who underwent SSRF had shorter MVDs, HLOS, and pneumonia incidence [ 33 ].…”

Videoassistierte Thorakoskopie (VATS) beim Thoraxtrauma

“…Die prozentuale Verteilung der Lungenverletzungen war für beide Gruppen identisch. Die Studie zeigt den hohen Anteil an intrathorakalen Begleitverletzungen bei Rippenserienfrakturen, sodass die Autoren aufgrund der Behandlungsvorteile für "VATS plus Rippenosteosynthese" das kombinierte operative Vorgehen empfehlen [41]. In mehreren Kohorten wird aufgrund der Detektion und thorakoskopischen Sanierung von intrathorakalen Begleitverletzungen sowie der Möglichkeit der Entlastung des retinierten Hämatothorax die Empfehlung zur Durchführung einer VATS im Rahmen der Thoraxwandosteosynthese gegeben [44,45,46].…”

“…Osteosynthesen der Thoraxwand werden offen, rein minimalinvasiv oder mit VATS-Unterstützung durchgeführt [37,38,40,41,42]. Während die rein minimalinvasive Versorgung von Rippenfrakturen noch in der Entwicklungsphase steht [43], ist zu klären, inwieweit die thorakoskopische Assistenz einen Vorteil bez.…”