Outcomes of Video-assisted Thoracic Surgery-guided Early Evacuation of Traumatic Hemothorax: A Randomized Pilot Study at Level I Trauma Center.

IF 1.2 Q3 EMERGENCY MEDICINE Journal of Emergencies, Trauma, and Shock Pub Date : 2024-04-01 Epub Date: 2024-06-26 DOI:10.4103/jets.jets_132_23
Abhinav Kumar, Dinesh Gora, Dinesh Bagaria, Pratyusha Priyadarshini, Narendra Choudhary, Amit Priyadarshi, Sahil Gupta, Junaid Alam, Amit Gupta, Biplab Mishra, Subodh Kumar, Sushma Sagar
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Abstract

Introduction: Traumatic hemothorax is accounted for about 20% of traumatic chest injuries. Although majority can be managed with the timely placement of intercostal tube (ICT) drainage, the remaining pose a challenge owing to high complication rates associated with retained hemothorax. Although various treatment modalities including intrapleural instillation of fibrinolytics, radioimage guided drainage, VATS guided evacuation and thoractomy do exist to address the retained hemothorax, but indications along with timing to employ a specific treatment option is still unclear and ambiguous.

Methods: Patient with residual hemothorax (>200 mL) on ultrasonography after 48 h of indwelling ICT was randomized into either early video-assisted thoracic surgery (VATS) or conventional approach cohort. Early VATS cohort was subjected to video-assisted thoracoscopic evacuation of undrained blood along with normal saline irrigation and ICT placement. The conventional cohort underwent intrapleural thrombolytic instillation for 3 consecutive days. The outcome measures were the duration of indwelling ICT, removal rate of tube thoracostomy, length of hospital stay, duration of intensive care unit (ICU) monitoring, need for mechanical ventilation, incidence of pulmonary and pleural complications, and requirement of additional intervention to address undrained hemothorax and mortality rate.

Results: The early VATS cohort had shorter length of hospital stay (7.50 ± 0.85 vs. 9.50 ± 3.03, P = 0.060), reduced duration of indwelling ICT (6.70 ± 1.25 vs. 8.30 ± 2.91, P = 0.127) with higher rate of tube thoracostomy removal (70% vs. 30%, P = 0.003) and lesser need of additional interventions (0% vs. 30%, P = 0.105). Thoracotomy (3 patients) and image-guided drainage (4 patients) were additional interventions to address retained hemothorax in the conventional cohort. However, similar length of ventilator assistance (0.7 ± 0.48 vs. 0.60 ± 1.08, P = 0.791) and prolonged ICU monitoring (1.30 ± 1.06 vs. 0.90 ± 1.45, P = 0.490) was observed in early VATS cohort. Both the cohorts had no mortality.

Conclusion: VATS-guided early evacuation of traumatic hemothorax is associated with shorter length of hospital stay along with abbreviated indwelling ICT duration, reduced incidence of complications, lesser readmissions, and improved rate of tube thoracostomy removal. However, the duration of ventilator requirement, ICU stay, and mortality remain unchanged.

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视频辅助胸腔手术指导下早期排出创伤性血气胸的效果:一级创伤中心的随机试点研究。
简介创伤性血胸约占胸部创伤的 20%。虽然大部分血胸可通过及时置入肋间管(ICT)引流得到控制,但由于血胸残留的并发症发生率较高,其余的血胸也构成了挑战。虽然有各种治疗方法,包括胸膜内灌注纤维蛋白溶解剂、放射影像引导下引流、VATS 引导下排空和胸廓切开术来处理残留血胸,但采用特定治疗方案的适应症和时机仍不明确:方法: 将留置 ICT 48 小时后超声检查有残留血胸(>200 mL)的患者随机分为早期视频辅助胸腔手术(VATS)组和传统方法组。早期视频辅助胸腔镜手术组接受视频辅助胸腔镜排空未排出的血液,同时用生理盐水冲洗并置入 ICT。传统方法组则连续3天进行胸腔内溶栓灌注。结果指标包括留置ICT的持续时间、管式胸腔造口的移除率、住院时间、重症监护室(ICU)监测持续时间、机械通气需求、肺部和胸膜并发症的发生率、处理未排出血胸的额外干预需求以及死亡率:早期 VATS 患者的住院时间较短(7.50 ± 0.85 vs. 9.50 ± 3.03,P = 0.060),留置 ICT 的时间较短(6.70 ± 1.25 vs. 8.30 ± 2.91,P = 0.127),胸腔造口管拔除率较高(70% vs. 30%,P = 0.003),需要额外干预的情况较少(0% vs. 30%,P = 0.105)。胸廓切开术(3 名患者)和图像引导引流术(4 名患者)是常规队列中解决残留血胸的额外干预措施。然而,在早期 VATS 组别中观察到了相似的呼吸机辅助时间(0.7 ± 0.48 vs. 0.60 ± 1.08,P = 0.791)和 ICU 监测时间(1.30 ± 1.06 vs. 0.90 ± 1.45,P = 0.490)。两组患者均无死亡:结论:VATS 引导下的创伤性血胸早期排空与缩短住院时间、缩短留置 ICT 时间、降低并发症发生率、减少再入院率和提高胸腔造口管拔除率有关。但是,呼吸机需求时间、重症监护室住院时间和死亡率保持不变。
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CiteScore
2.90
自引率
7.10%
发文量
52
审稿时长
39 weeks
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