Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma

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Abstract

Purpose of review

In the last decade, video-assisted thoracoscopic surgery (VATS) has become a popular method in diagnosis and treatment of acute chest injuries. Except for patients with unstable vital signs who require larger surgical incisions to check bleeding, this endoscopic surgery could be employed in the majority of thoracic injury patients with stable vital signs.

Recent findings

In the past, VATS was used to evacuate traumatic-retained hemothorax. Recent study has revealed further that lung repair during VATS could decrease complications after trauma. Management of fractured ribs could also be assisted by VATS. Early VATS intervention within 7 days after injury can decrease the rate of posttraumatic infection and length of hospital stay. In studies of the pathophysiology of animal models, N-acetylcysteine and methylene blue were used in animals with blunt chest trauma and found to improve clinical outcomes.

Summary

Retained hemothorax derived from blunt chest trauma should be managed carefully and rapidly. Early VATS intervention is a well tolerated and reliable procedure that can be applied to manage this complication cost effectively.

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Most cited references 49

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Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience

Michael Ried, Thomas Bein, Alois Philipp … (2013)

Introduction Severe trauma with concomitant chest injury is frequently associated with acute lung failure (ALF). This report summarizes our experience with extracorporeal lung support (ELS) in thoracic trauma patients treated at the University Medical Center Regensburg. Methods A retrospective, observational analysis of prospectively collected data (Regensburg ECMO Registry database) was performed for all consecutive trauma patients with acute pulmonary failure requiring ELS during a 10-year interval. Results Between April 2002 and April 2012, 52 patients (49 male, three female) with severe thoracic trauma and ALF refractory to conventional therapy required ELS. The mean age was 32 ± 14 years (range, 16 to 72 years). Major traffic accident (73%) was the most common trauma, followed by blast injury (17%), deep fall (8%) and blunt trauma (2%). The mean Injury Severity Score was 58.9 ± 10.5, the mean lung injury score was 3.3 ± 0.6 and the Sequential Organ Failure Assessment score was 10.5 ± 3. Twenty-six patients required pumpless extracorporeal lung assist (PECLA) and 26 patients required veno-venous extracorporeal membrane oxygenation (vv-ECMO) for primary post-traumatic respiratory failure. The mean time to ELS support was 5.2 ± 7.7 days (range, <24 hours to 38 days) and the mean ELS duration was 6.9 ± 3.6 days (range, <24 hours to 19 days). In 24 cases (48%) ELS implantation was performed in an external facility, and cannulation was done percutaneously by Seldinger's technique in 98% of patients. Cannula-related complications occurred in 15% of patients (PECLA, 19% (n = 5); vv-ECMO, 12% (n = 3)). Surgery was performed in 44 patients, with 16 patients under ELS prevention. Eight patients (15%) died during ELS support and three patients (6%) died after ELS weaning. The overall survival rate was 79% compared with the proposed Injury Severity Score-related mortality (59%). Conclusion Pumpless and pump-driven ELS systems are an excellent treatment option in severe thoracic trauma patients with ALF and facilitate survival in an experienced trauma center with an interdisciplinary treatment approach. We encourage the use of vv-ECMO due to reduced complication rates, better oxygenation and best short-term outcome.

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Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model

Ceri Battle, Hayley Hutchings, Simon Lovett … (2014)

Introduction Blunt chest wall trauma accounts for over 15% of all trauma admissions to Emergency Departments worldwide. Reported mortality rates vary between 4 and 60%. Management of this patient group is challenging as a result of the delayed on-set of complications. The aim of this study was to develop and validate a prognostic model that can be used to assist in the management of blunt chest wall trauma. Methods There were two distinct phases to the overall study; the development and the validation phases. In the first study phase, the prognostic model was developed through the retrospective analysis of all blunt chest wall trauma patients (n = 274) presenting to the Emergency Department of a regional trauma centre in Wales (2009 to 2011). Multivariable logistic regression was used to develop the model and identify the significant predictors for the development of complications. The model’s accuracy and predictive capabilities were assessed. In the second study phase, external validation of the model was completed in a multi-centre prospective study (n = 237) in 2012. The model’s accuracy and predictive capabilities were re-assessed for the validation sample. A risk score was developed for use in the clinical setting. Results Significant predictors of the development of complications were age, number of rib fractures, chronic lung disease, use of pre-injury anticoagulants and oxygen saturation levels. The final model demonstrated an excellent c-index of 0.96 (95% confidence intervals: 0.93 to 0.98). Conclusions In our two phase study, we have developed and validated a prognostic model that can be used to assist in the management of blunt chest wall trauma patients. The final risk score provides the clinician with the probability of the development of complications for each individual patient.

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Role of alveolar macrophages in the inflammatory response after trauma.

Ulrike Niesler, Annette Palmer, Peter Radermacher … (2014)

Acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS), can result from both direct and indirect pulmonary damage caused by trauma and shock. In the course of ALI/ARDS, mediators released from resident cells, such as alveolar macrophages, may act as chemoattractants for invading cells and stimulate local cells to build up a proinflammatory micromilieu. Depending on the trauma setting, the role of alveolar macrophages is differentially defined. This review focuses on alveolar macrophage function after blunt chest trauma, ischemia/reperfusion, hemorrhagic shock, and thermal burns.

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Author and article information

Journal

Journal ID (nlm-ta): Curr Opin Pulm Med

Journal ID (iso-abbrev): Curr Opin Pulm Med

Journal ID (publisher-id): COPME

Title: Current Opinion in Pulmonary Medicine

Publisher: Lippincott Williams & Wilkins

ISSN (Print): 1070-5287

ISSN (Electronic): 1531-6971

Publication date (Print): July 2015

Publication date (Electronic): 27 May 2015

Volume: 21

Issue: 4

Pages: 393-398

Affiliations

[a ]Division of Trauma, Department of Emergency, Kaohsiung Veterans General Hospital, Kaohsiung

[b ]Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Kweishan, Taoyuan

[c ]Department of Emergency, Foo-Yin University Hospital, Pingtung County

[d ]Division of Chest Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital

[e ]School of Medicine, Chung Shan Medical University, Taichung

[f ]Department of Pharmacy, Tajen University, Pingtung

Author notes

Correspondence to Tzu-Chin Wu, Division of Chest Medicine, Department of Internal Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N.Rd., Taichung 40201, Taiwan. Tel: +886 4 24730022; e-mail: tcwu@ 123456csmu.edu.tw

Article

Accession ID: 00016

DOI: 10.1097/MCP.0000000000000173

PMC ID: 5633323

PubMed ID: 25978625

SO-VID: 2b9592d8-575f-4369-b573-9592b73f8da4

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This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0

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Keywords: blunt chest trauma,retained hemothorax,video-assisted thoracoscopic surgery

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Keywords: blunt chest trauma, retained hemothorax, video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma

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Abstract

Purpose of review

Recent findings

Summary

Related collections

SICOT-J (Orthopedic surgery and traumatology)

Most cited references 49

Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience

Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model

Role of alveolar macrophages in the inflammatory response after trauma.

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