Thoracic Packing for Uncontrolled Bleeding in Penetrating Thoracic Injuries

Abstract

We present a series of three patients who suffered penetrating thoracic injury, and in whom thoracic packing was used as a life-saving procedure. Survival among these patients paralleled the severity and extent of the original injuries. Restriction of cardiac filling and lung expansion are potential deterrents from using this technique; however, its use seems to be a valid adjunct, especially in the setting of chest wall bleeding coming from the intercostal arteries. Damage control surgery in pentrating thoracic trauma, including thoracic packing, is a sound alternative when uncontrollable bleeding, hypothermia and coagulopathy compromises the survival of a patient.

Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients

“…11, 42 The reported indications assessed to be appropriate for the use of therapeutic mediastinal and/or pleural space packing and temporary thoracic closure included inability to control bleeding using conventional methods (due to a coagulopathy or for other reasons) and the development of a thoracic compartment syndrome during attempted thoracic wall closure, respectively. Although therapeutic intrathoracic packing may impair lung expansion and cardiac filling, 14,15,43 this intervention has been reported to be useful to tamponade uncontrollable, coagulopathic oozing from the chest wall, upper mediastinum or apex of the pleural cavity, perivertebral space, and space down in the sulcus away from the heart and hilum. 14,15,43 Thoracic compartment syndrome is a rare condition thought to occur secondary to resuscitation fluid-related cardiac edema and typically presents with increased peak inspiratory pressures, decreased cardiac output, and hypotension.…”

“…Although therapeutic intrathoracic packing may impair lung expansion and cardiac filling, 14,15,43 this intervention has been reported to be useful to tamponade uncontrollable, coagulopathic oozing from the chest wall, upper mediastinum or apex of the pleural cavity, perivertebral space, and space down in the sulcus away from the heart and hilum. 14,15,43 Thoracic compartment syndrome is a rare condition thought to occur secondary to resuscitation fluid-related cardiac edema and typically presents with increased peak inspiratory pressures, decreased cardiac output, and hypotension. 44Y46 The indication assessed to be appropriate and most commonly reported for the use of therapeutic perihepatic packing included the development of a coagulopathy in a patient undergoing laparotomy for a liver injury.…”

Damage Control Surgery for Abdominal Trauma

“…Use of principles of DCS at the right time will save the life of critically ill trauma patients [37]. Regardless of the increased morbidity, the principles of damage control are here to stay, and in fact are being extended to orthopaedic and thoracic trauma [38,39].…”

Delayed Cardiac Rupture Induced by Traumatic Myocardial Infarction: Consequence of a 45-Magnum Blast Injury; A Comprehensive Case Review

“…That is why the pleural cavity can be packed generously in case of a blood leakage without provoking a compression of the lung or the big vessels [58]. This "packing" is an essential and vital damage-controlprocedure [30,46,50,56,57,[59][60][61][62][63][64][65].…”