Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 7/2018

Open Access 01-07-2018 | Original Scientific Report

Early Management of Retained Hemothorax in Blunt Head and Chest Trauma

Authors: Fong-Dee Huang, Wen-Bin Yeh, Sheng-Shih Chen, Yuan-Yuarn Liu, I-Yin Lu, Yi-Pin Chou, Tzu-Chin Wu

Published in: World Journal of Surgery | Issue 7/2018

Login to get access

Abstract

Background

Major blunt chest injury usually leads to the development of retained hemothorax and pneumothorax, and needs further intervention. However, since blunt chest injury may be combined with blunt head injury that typically requires patient observation for 3–4 days, other critical surgical interventions may be delayed. The purpose of this study is to analyze the outcomes of head injury patients who received early, versus delayed thoracic surgeries.

Materials and methods

From May 2005 to February 2012, 61 patients with major blunt injuries to the chest and head were prospectively enrolled. These patients had an intracranial hemorrhage without indications of craniotomy. All the patients received video-assisted thoracoscopic surgery (VATS) due to retained hemothorax or pneumothorax. Patients were divided into two groups according to the time from trauma to operation, this being within 4 days for Group 1 and more than 4 days for Group 2. The clinical outcomes included hospital length of stay (LOS), intensive care unit (ICU) LOS, infection rates, and the time period of ventilator use and chest tube intubation.

Result

All demographics, including age, gender, and trauma severity between the two groups showed no statistical differences. The average time from trauma to operation was 5.8 days. The ventilator usage period, the hospital and ICU length of stay were longer in Group 2 (6.77 vs. 18.55, p = 0.016; 20.63 vs. 35.13, p = 0.003; 8.97 vs. 17.65, p = 0.035). The rates of positive microbial cultures in pleural effusion collected during VATS were higher in Group 2 (6.7 vs. 29.0%, p = 0.043). The Glasgow Coma Scale score for all patients improved when patients were discharged (11.74 vs. 14.10, p < 0.05).

Discussion

In this study, early VATS could be performed safely in brain hemorrhage patients without indication of surgical decompression. The clinical outcomes were much better in patients receiving early intervention within 4 days after trauma.
Literature
1.
Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons (2007) Guidelines for the management of severe traumatic brain injury. J Neurotrauma 24(Suppl 1):S1–106
2.
Robertson CS, Valadka AB, Hannay HJ et al (1999) Prevention of secondary ischemic insults after severe head injury. Crit Care Med 27(2086–209):5
3.
Kalb DC, Ney AL, Rodriguez JL et al (1998) Assessment of the relationship between timing of fixation of the fracture and secondary brain injury in patients with multiple trauma. Surgery 124:739–744 (discussion 744–735) CrossRefPubMed
4.
Yokobori S, Watanabe A, Matsumoto G et al (2011) Time course of recovery from cerebral vulnerability after severe traumatic brain injury: a microdialysis study. J Trauma 71:1235–1240CrossRefPubMed
5.
Heniford BT, Carrillo EH, Spain DA et al (1997) The role of thoracoscopy in the management of retained thoracic collections after trauma. Ann Thorac Surg 63(940–94):3
6.
Helling TS, Gyles NR 3rd, Eisenstein CL et al (1989) Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy. J Trauma 29:1367–1370CrossRefPubMed
7.
Eddy AC, Luna GK, Copass M (1989) Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma. Am J Surg 157(494–49):7
8.
Richardson JD, Carrillo E (1997) Thoracic infection after trauma. Chest Surg Clin N Am 7(401–42):7
9.
Meyer DM, Jessen ME, Wait MA et al (1997) Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial. Ann Thorac Surg 64:1396–1400 (discussion 1400–1391) CrossRefPubMed
10.
Carrillo EH, Richardson JD (2005) Thoracoscopy for the acutely injured patient. Am J Surg 190(234–23):8
11.
McManus K, McGuigan J (1994) Minimally invasive therapy in thoracic injury. Injury 25(609–61):4
12.
Dennis BM, Gondek SP, Guyer RA et al (2017) Use of an evidence-based algorithm for patients with traumatic hemothorax reduces need for additional interventions. J Trauma Acute Care Surg 82(728–73):2
13.
Mergo PJ, Helmberger T, Didovic J et al (1999) New formula for quantification of pleural effusions from computed tomography. J Thorac Imaging 14(122–12):5
14.
Chou YP, Lin HL, Wu TC (2015) Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma. Curr Opin Pulm Med 21(393–39):8
15.
Morales Uribe CH, Villegas Lanau MI, Petro Sanchez RD (2008) Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax. Surg Endosc 22(91–9):5
16.
Smith JW, Franklin GA, Harbrecht BG et al (2011) Early VATS for blunt chest trauma: a management technique underutilized by acute care surgeons. J Trauma 71:102–105 (discussion 105–107) CrossRefPubMed
17.
Tuttle MS, Smith WR, Williams AE et al (2009) Safety and efficacy of damage control external fixation versus early definitive stabilization for femoral shaft fractures in the multiple-injured patient. J Trauma 67(602–60):5
18.
Lin HL, Huang WY, Yang C et al (2014) How early should VATS be performed for retained haemothorax in blunt chest trauma? Injury 45:1359–1364CrossRefPubMed
19.
Kumar S, Rathi V, Rattan A et al (2015) VATS versus intrapleural streptokinase: a prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax. Injury 46:1749–1752CrossRefPubMed
Metadata
Title
Early Management of Retained Hemothorax in Blunt Head and Chest Trauma
Authors
Fong-Dee Huang
Wen-Bin Yeh
Sheng-Shih Chen
Yuan-Yuarn Liu
I-Yin Lu
Yi-Pin Chou
Tzu-Chin Wu
Publication date
01-07-2018
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 7/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-017-4420-x

Other articles of this Issue 7/2018

World Journal of Surgery 7/2018 Go to the issue

Original Scientific Report

Topical Minoxidil Versus Topical Diltiazem for Chemical Sphincterotomy of Chronic Anal Fissure: A Prospective, Randomized, Double-Blind, Clinical Trial

Original Scientific Report

Concentration of Proteasome in the Blood Plasma of Children with Acute Appendicitis, Before and After Surgery, and Its Correlation with CRP

Original Scientific Report

The Benefit of Ultrasound in Deciding Between Tube Thoracostomy and Observative Management in Hemothorax Resulting from Blunt Chest Trauma

Original Scientific Report

American College of Surgeons Member Involvement in Global Surgery: Results from the 2015 Operation Giving Back Survey

Letter to the Editor

Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies

Original Scientific Report

Long-Lasting Voice-Related Symptoms in Patients Without Vocal Cord Palsy After Thyroidectomy