Management of post-traumatic retained hemothorax: A prospective, observational, multicenter AAST study

被引:99
作者
DuBose, Joseph [1 ]
Inaba, Kenji [2 ]
Demetriades, Demetrios [2 ]
Scalea, Thomas M.
O'Connor, James
Menaker, Jay
Morales, Carlos [3 ]
Konstantinidis, Agathoklis [2 ]
Shiflett, Anthony [4 ]
Copwood, Ben [5 ]
机构
[1] Univ Maryland, Med Syst, AF CSTARS Baltimore, R Adams Cowley Shock Trauma Ctr, Baltimore, MD 21201 USA
[2] Los Angeles Cty Univ So Calif Hosp, Los Angeles, CA USA
[3] Univ Antioquia, Hosp Univ San Vicente de Paul, Medellin, Colombia
[4] Washington Hosp Ctr, Washington, DC 20010 USA
[5] Univ Med Ctr Brackenridge, Austin, TX USA
关键词
Hemothorax; trauma; thoracostomy; thoracotomy; empyema; INTRAPLEURAL STREPTOKINASE; THORACOSCOPIC EVACUATION; TRAUMATIC HEMOTHORAX; PLEURAL EFFUSIONS; RANDOMIZED-TRIAL; EMPYEMA-THORACIS; RISK-FACTORS; INJURY; FIBRINOLYTICS; EXPERIENCE;
D O I
10.1097/TA.0b013e318242e368
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND: The natural history and optimal management of retained hemothorax (RH) after chest tube placement is unknown. The intent of our study was to determine practice patterns used and identify independent predictors of the need for thoracotomy. METHODS: An American Association for the Surgery of Trauma multicenter prospective observational trial was conducted, enrolling patients with placement of chest tube within 24 hours of trauma admission and RH on subsequent computed tomography of the chest. Demographics, interventions, and outcomes were analyzed. Logistic regression analysis was used to identify the independent predictors of successful intervention for each of the management choices chosen and complications. RESULTS: RH was identified in 328 patients from 20 centers. Video-assisted thoracoscopy (VATS) was the most commonly used initial procedure in 33.5%, but 26.5% required two and 5.4% required three procedures to clear RH or subsequent empyema. Thoracotomy was ultimately required in 20.4%. The strongest independent predictor of successful observation was estimated volume of RH <= 300 cc (odds ratio [OR], 3.7 [2.0-7.0]; p < 0.001). Independent predictors of successful VATS as definitive treatment were absence of an associated diaphragm injury (OR, 4.7 [1.6-13.7]; p = 0.005), use of periprocedural antibiotics for thoracostomy placement (OR, 3.3 [1.2-9.0]; p = 0.023), and volume of RH <= 900 cc (OR, 3.9 [1.4-13.2]; p = 0.03). No relationship between timing of VATS and success rate was identified. Independent predictors of the need for thoracotomy included diaphragm injury (OR, 4.9 [2.4-9.9]; p < 0.001), RH > 900 cc (OR, 3.2 [1.4-7.5]; p = 0.007), and failure to give periprocedural antibiotics for initial chest tube placement (OR 2.3 [1.2-4.6]; p = 0.015). The overall empyema and pneumonia rates for RH patients were 26.8% and 19.5%, respectively. CONCLUSION: RH in trauma is associated with high rates of empyema and pneumonia. VATS can be performed with high success rates, although optimal timing is unknown. Approximately, 25% of patients require at least two procedures to effectively clear RH or subsequent pleural space infections and 20.4% require thoracotomy. (J Trauma. 2012; 72: 11-24. Copyright (C) 2012 by Lippincott Williams & Wilkins)
引用
收藏
页码:11 / 22
页数:12
相关论文
共 42 条
[1]  
Aguilar MM, 1997, ARCH SURG-CHICAGO, V132, P647
[2]  
[Anonymous], ARCH SURG
[3]   USE OF PURIFIED STREPTOKINASE IN EMPYEMA AND HEMOTHORAX [J].
AYE, RW ;
FROESE, DP ;
HILL, LD .
AMERICAN JOURNAL OF SURGERY, 1991, 161 (05) :560-562
[4]   Risk Factors for Empyema After Diaphragmatic Injury: Results of a National Trauma Databank Analysis [J].
Barmparas, Galinos ;
DuBose, Joseph ;
Teixeira, Pedro G. R. ;
Recinos, Gustavo ;
Inaba, Kenji ;
Plurad, David ;
Green, D. J. ;
Demetriades, Demetrios .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2009, 66 (06) :1672-1676
[5]   Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema [J].
Bouros, D ;
Schiza, S ;
Tzanakis, N ;
Drositis, J ;
Siafakas, N .
EUROPEAN RESPIRATORY JOURNAL, 1996, 9 (08) :1656-1659
[6]   Intrapleural streptokinase versus urokinase in the treatment of complicated parapneumonic effusions - A prospective, double-blind study [J].
Bouros, D ;
Schiza, S ;
Patsourakis, G ;
Chalkiadakis, G ;
Panagou, P ;
Siafakas, NM .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1997, 155 (01) :291-295
[7]  
Bouros D, 1999, Monaldi Arch Chest Dis, V54, P258
[8]   Treatment of sonographically stratified multiloculated thoracic empyema by medical thoracoscopy [J].
Brutsche, MH ;
Tassi, GF ;
Györik, S ;
Gökcimen, M ;
Renard, C ;
Marchetti, CP ;
Tschopp, JM .
CHEST, 2005, 128 (05) :3303-3309
[9]  
Cameron R, 2008, COCHRANE DB SYST REV, V16, DOI DOI 10.1002/14651858.CD002312.PUB3
[10]  
Carrillo E H, 1998, Curr Opin Pulm Med, V4, P243, DOI 10.1097/00063198-199807000-00012