Management of patients with blunt thoracic trauma and hemopneumothorax

Abstract

Introduction. Trauma is the leading cause of death worldwide. Approximately 70% of polytraumatized patients have thoracic trauma(TT) with variable severity, the pleuropulmonary complications reaching up to 30-45%, depending on the severity of the trauma. Aim of the study. Analysis of the diagnostic and treatment outcomes in patients with blunt chest trauma and hemopneumothorax(HPT). Materials and methods. A prospective study, performed on 86 patients with TT and HPT, hospitalized consecutively at Institute of Emergency Medicine in 2019. The epidemiology, trauma-hospitalization time, hospitalization-tube thoracostomy(TThS), ISS score, structure of associated lesions, duration of assisted ventilation, cause, the frequency of repeated of TThS were analyzed. Results. M:F–3,5:1; mean age–51,2±1,8years; In 39(45,3%) TT was caused by falling from its own height, in 27(31,4%) – physical aggression, in 14(16,3%) – motor vehicle collision, in 6(7%) – falling from the height. Chest x-ray was performed on 83(96.5%) patients, in 27(32.5%) cases HPT on hospitalization was not found, FAST – 79(91.9%), only in 10(12.7%) cases pleural collections and/or emphysema was found. CT was performed on 19(22.1%) cases, sensitivity 100% for HPT. At 21(24.4%) polytraumatized patients TT was associated with: abdominal trauma in 4(19%), traumatic brain injury(TBI) – 14(66.6%), trauma of locomotor system – 12(57.1%), vertebral trauma – 4(19%). Hemodynamic unstable patients were 3(3,5%), with ISS>25. Were hospitalized in intensive care unit 16(18.6%) patients, 2 were connected to mechanical ventilation(MV) upon admission; 4(25%) for developing ARDS; and 4(25%) for TBI (2 with GCS<10). Unilateral TT was found in 84(97.7%), of which 12(14.3%)polytraumatized, 19(22.6%) with HT, 42(50%) – PT, and 23(27.4%) with HPT. Bilateral TT – 2(2.3%), in one case with HPT with flail chest, the other case – HT (ISS>20). TThS upon admission was made in 64(74.4%) cases, until 24h at 12(14%) patients and over 24h at 10(11.6%) patients. TThS was performed in all cases, 53(61,6%) cases in the 5th intercostal space, 27(31,4%) for PT in the 2nd and 6(6,7%) in the 2nd and 5th. In one case, videothoracoscopy was performed 17 hours after TThS for haemostasis. TThS was required repeatedly in 3(3.5%) cases. The average length of hospitalization was 8.34±6.6days and depended directly on the associated lesions and the duration of MV. Mortality was 3.5% (n=3), the cause being hypovolemic shock and MODS. Conclusions. The hemodynamic stability is determining the management of chest trauma and HPT. The thoracic x-ray is negative in about ¼ cases at admission. FAST in hemodynamically unstable patients with TT can appreciate the presence of HPT. Thoracic CT has the biggest sensitivity for HPT. Repeated TThS are determined by MV and the severity of TBI. Morbidity is dependent on pulmonary contusion, prolonged MV, consciousness disorders and late mobilization.