Trauma torácico: fatores de risco de complicações pleuropulmonares pós-drenagem pleural fechada

Abstract

O objetivo do presente estudo foi avaliar a importância dos fatores de risco na gênese das complicações pleuropulmonares, pós-drenagem pleural fechada. Analisou-se, prospectivamente, no período de janeiro de 1998 a junho de 1999, um total de 167 pacientes submetidos à drenagem pleural fechada, sendo estratificados em dois grupos selecionados para um estudo de acompanhamento de coortes. Ao grupo controle, de 104 pacientes, não foi administrada antibioticoterapia e, no grupo experimental, de 63 pacientes, a cefalotina foi a droga utilizada. A idade no grupo-controle variou entre 13 e 53 anos (26,8±8,9) e no grupo experimental entre 15 e 57 (24,9±7,9), predominando o sexo masculino (95,2%), nos dois grupos estudados. O trauma aberto incidiu em 92,8% dos pacientes, com predominância para as feridas por arma branca em 58,7%, contra 24,6% de feridas por projétil de arma de fogo. As complicações pleuropulmonares estiveram presentes em 35 pacientes (33,78%) do grupo controle, ao passo que, no grupo experimental, apenas 18 (28,6%) evoluíram com este tipo de complicação. Não ocorreram óbitos em ambas as séries estudadas. Nas análises estatísticas, o modelo bivariado mostrou que o tipo de trauma e o tempo de drenagem pleural foram as variáveis que mais importância tiveram como fatores preditivos de complicações. Na análise de regressão logística multivariada, as variáveis tempo de internação, trauma fechado e volume de sangue drenado maior do que 500ml, quando associadas, influenciaram de maneira positiva a ocorrência de complicações.

Associated factors to empyema in post-traumatic hemotorax

“…The literature tends to high quote the penetrating mechanism as a risk factor for empyema, but this is controversial and the reasons are not objectively clarified 3,4,12,16 . Another study in Brazil has found similar results to this work regarding the incidence of empyema according to the mechanism of trauma 19 . In this work, the finding may be explained by the patient's age effect, once among the 33 patients with penetrating trauma by firearms, only two were older than 40 years (6%), as opposed to 13 among the remaining 28 with penetrating trauma by knife or blunt trauma (46.4%) (data not shown).…”

“…In this work the incidence was 32.8%, 16.4%, and 4.9% for empyema, pneumonia and infected pulmonary contusion, respectively. Empyema demands surgical treatment in some cases, being one intrathoracic complication with serious damage for patients 19 . Patients with penetrating trauma by firearms had significantly lower risk of empyema compared to those with penetrating trauma with knives and blunt trauma.…”

“…This fact means that, in the present study, patients with different trauma of those by firearms were older, with higher incidence of empyema (compared to the other age groups) among those over 40 years. Age is a risk factor in post-traumatic pleural empyema, because elderly patients have less cardiovascular and respiratory physiological reserves and more associated chronic diseases with propensity to retain pulmonar secretions 19 . There was a higher incidence of empyema when the injury was on the left side of the thorax, but without statistical significance.…”

“…Empyema associated to longer time is expected, once the incidence of infection is increased after 72 hours of the drain insertion in the pleural cavity 19 . But the length of hospital stay was significantly higher among patients who developed empyema, which is predictable because, in the presence of complication, the patients have more suffering, besides an extended hospital staying and also, more costs to the patients, hospital and society itself.…”

“…The literature also highlights selected factors associated with the presence of empyema such as age, mechanisms of trauma (blunt or penetrating), side of the thoracic injury, exploratory laparotomy, severity of the patient, time and the RH diagnostic method, primary indication for PD, drained volume, permanence of the drain, need of redrainage, length of stay and surgical procedures 18,19 . It is generally agreed that aseptic techniques of PD and complete evacuation of RH are necessary to avoid complications.…”