Management of Thoracic Trauma in Intensive Care Unit in Togo: A Particular Reference to Sylvanus Olympio University Hospital of Lome

Abstract

Background: The Management of thoracic trauma (TT) requires important resources, especially for intensive cares. In developing countries, intensive care units (ICUs) are often the first facilities providing life-saving care to severe trauma patients. This study aimed to analyze the management of TT in a Togolese ICU.Methods: A retrospective and descriptive study was carried out in the ICU of the SylvanusOlympio University Hospital (SO UH) of Lomé, over a six-year period. The records of TT inpatients were analyzed from registers. Statistical tests were performed using Epi-info 7.2.4 software. Results: Of the inpatients for resuscitation, one hundred and ninety-five patients (195) were admitted with TT (5.1% of ICU admission), with 187 selected for the research. Their mean age was 38.1 ± 13 years and sex-ratio = 6.8. Road Traffic Accidents (RTA) were the most frequent causes (87.2%). Patients had respiratory distress (62.6%), hemorrhagic shock (4.8%) and severe coma (24.6%). It was polytrauma in 92.5% of the cases with 75.9% of cranio-encephalic injuries. Fifty patients underwent surgery. Resuscitation included oxygen therapy (65.8%), mechanical ventilation (15%), decompression needle thoracostomy (11.2%), chest drainage (10.7%), analgesia, sedation (54%), vascular filling (21.9%), administration of vasopressors (14.4%) and blood transfusion (49.7%). The mean length for ICU stay was 12.7 ± 6 days. At least one complication occurred in 55.8% of patients: sepsis in 43.3%, bronchopulmonary infection in 32.1%, acute respiratory distress syndrome (ARDS) in 25.7%, hemorrhagic shock in 16.6% and septic shock in 15%.Eighty-four patients (44.9%) died of septic shock (30.9%), hemorrhagic shock (14.3%), brain injuries (36.9%), and ARDS (9.5%). The management faced shortcomings such as inadequate aseptic conditions, unavailability of arterial blood gas test, insufficiency of surveillance monitors and ventilators. Conclusion: TTs were common in ICU. Most of the patients presented associated injuries. ICU management was successful in most cases, but faced challenges. It is necessary to improve equipment and management protocols.