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Critical Care
Published in: Critical Care 1/2020

01-12-2020 | Thoracic Trauma | Research

Facilitating ventilator weaning through rib fixation combined with video-assisted thoracoscopic surgery in severe blunt chest injury with acute respiratory failure

Authors: Tung-Ho Wu, Hsing-Lin Lin, Yi-Pin Chou, Fong-Dee Huang, Wen-Yen Huang, Yih-Wen Tarng

Published in: Critical Care | Issue 1/2020

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Abstract

Background

Severe blunt chest injury sometimes induces acute respiratory failure (ARF), requiring ventilator use. We aimed to evaluate the effect of performing rib fixation with the addition of video-assisted thoracoscopic surgery (VATS) on patients with ARF caused by blunt thoracic injury with ventilator dependence.

Methods

This observational study prospectively enrolled patients with multiple bicortical rib fractures with hemothorax caused by severe blunt chest trauma. All patients received positive pressure mechanical ventilation within 24 h after trauma because of ARF. Some patients who received rib fixation with VATS were enrolled as group 1, and the others who received only VATS were designated as group 2. The length of ventilator use was the primary clinical outcome. Rates of pneumonia and length of hospital stay constituted secondary outcomes.

Results

A total of 61 patients were included in this study. The basic demographic characteristics between the two groups exhibited no statistical differences. All patients received operations within 6 days after trauma. The length of ventilator use was shorter in group 1 (3.19 ± 3.37 days vs. 8.05 ± 8.23, P = 0.002). The rate of pneumonia was higher in group 2 (38.1% vs. 75.0%, P = 0.005). The length of hospital stay was much shorter in group 1 (17.76 ± 8.38 days vs. 24.13 ± 9.80, P = 0.011).

Conclusion

Rib fixation combined with VATS could shorten the length of ventilator use and reduce the pneumonia rate in patients with severe chest blunt injury with ARF. Therefore, this operation could shorten the overall length of hospital stay.
Literature
1.
Richardson JD, Miller FB, Carrillo EH, Spain DA. Complex thoracic injuries. Surg Clin North Am. 1996;76(4):725–48.PubMedCrossRef
2.
3.
Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995;110(6):1676–80.PubMedCrossRef
4.
Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, Shimazaki S. Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients. J Trauma. 2002;52(4):727–32 discussion 732.PubMed
5.
Heniford BT, Carrillo EH, Spain DA, Sosa JL, Fulton RL, Richardson JD. The role of thoracoscopy in the management of retained thoracic collections after trauma. Ann Thorac Surg. 1997;63(4):940–3.PubMedCrossRef
6.
DuBose J, Inaba K, Demetriades D, Scalea TM, O'Connor J, Menaker J, Morales C, Konstantinidis A, Shiflett A, Copwood B. Management of post-traumatic retained hemothorax: a prospective, observational, multicenter AAST study. J Trauma Acute Care Surg. 2012;72(1):11–22 discussion 22-14; quiz 316.PubMedCrossRef
7.
Wada T, Yasunaga H, Inokuchi R, Matsui H, Matsubara T, Ueda Y, Gunshin M, Ishii T, Doi K, Kitsuta Y, et al. Effectiveness of surgical rib fixation on prolonged mechanical ventilation in patients with traumatic rib fractures: a propensity score-matched analysis. J Crit Care. 2015;30(6):1227–31.PubMedCrossRef
8.
Kocher GJ, Sharafi S, Azenha LF, Schmid RA. Chest wall stabilization in ventilator-dependent traumatic flail chest patients: who benefits? Eur J Cardio-thorac Surg. 2017;51(4):696–701.
9.
DeFreest L, Tafen M, Bhakta A, Ata A, Martone S, Glotzer O, Krautsak K, Rosati C, Stain SC, Bonville D. Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest. Am J Surg. 2016;211(4):761–7.PubMedCrossRef
10.
Brasel KJ, Moore EE, Albrecht RA, de Moya M, Schreiber M, Karmy-Jones R, Rowell S, Namias N, Cohen M, Shatz DV, et al. Western trauma association critical decisions in trauma: management of rib fractures. J Trauma Acute Care Surg. 2017;82(1):200–3.PubMedCrossRef
11.
Lin HL, Tarng YW, Wu TH, Huang FD, Huang WY, Chou YP. The advantages of adding rib fixations during VATS for retained hemothorax in serious blunt chest trauma - a prospective cohort study. Int J Surg. 2019;65:13–8.PubMedCrossRef
12.
Mergo PJ, Helmberger T, Didovic J, Cernigliaro J, Ros PR, Staab EV. New formula for quantification of pleural effusions from computed tomography. J Thorac Imaging. 1999;14(2):122–5.PubMedCrossRef
13.
Tyburski JG, Collinge JD, Wilson RF, Eachempati SR. Pulmonary contusions: quantifying the lesions on chest X-ray films and the factors affecting prognosis. J Trauma. 1999;46(5):833–8.PubMedCrossRef
14.
Chou YP, Kuo LC, Soo KM, Tarng YW, Chiang HI, Huang FD, Lin HL. The role of repairing lung lacerations during video-assisted thoracoscopic surgery evacuations for retained haemothorax caused by blunt chest trauma. Eur J Cardio-Thorac Surg. 2014;46(1):107–11.CrossRef
15.
16.
Hasenboehler EA, Bernard AC, Bottiggi AJ, Moghadamian ES, Wright RD, Chang PK, Boulanger BR, Kearney PA. Treatment of traumatic flail chest with muscular sparing open reduction and internal fixation: description of a surgical technique. J Trauma. 2011;71(2):494–501.PubMedCrossRef
17.
Bhatnagar A, Mayberry J, Nirula R. Rib fracture fixation for flail chest: what is the benefit? J Am Coll Surg. 2012;215(2):201–5.PubMedCrossRef
18.
19.
Lin HL, Huang WY, Yang C, Chou SM, Chiang HI, Kuo LC, Lin TY, Chou YP. How early should VATS be performed for retained haemothorax in blunt chest trauma? Injury. 2014;45(9):1359–64.PubMedCrossRef
20.
21.
Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients—still a relevant problem? Scan J Trauma Resusc Emerg Med. 2017;25(1):42.CrossRef
22.
Bruns BR, Diaz JJ. Early and persistent hemothorax and pneumothorax. Curr Trauma Rep. 2015;1(4):251–6.CrossRef
23.
Huang F-D, Yeh W-B, Chen S-S, Liu Y-Y, Lu I-Y, Chou Y-P, Wu T-C. Early management of retained hemothorax in blunt head and chest trauma. World J Surg. 2018;42(7):2061–6.PubMedPubMedCentralCrossRef
24.
Marasco SF, Davies AR, Cooper J, Varma D, Bennett V, Nevill R, Lee G, Bailey M, Fitzgerald M. Prospective randomized controlled trial of operative rib fixation in traumatic flail chest. J Am Coll Surg. 2013;216(5):924–32.CrossRef
25.
Doben AR, Eriksson EA, Denlinger CE, Leon SM, Couillard DJ, Fakhry SM, Minshall CT. Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation. J Crit Care. 2014;29(1):139–43.PubMedCrossRef
26.
Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37(6):975–9.PubMedCrossRef
27.
Gülhan E, Türüt H, Taştepe I, Kaya S, Topçu S, Yazici Ü, Sirmali M. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg. 2003;24(1):133–8.PubMedCrossRef
28.
Tarng Y-W, Liu Y-Y, Huang F-D, Lin H-L, Wu T-C, Chou Y-P. The surgical stabilization of multiple rib fractures using titanium elastic nail in blunt chest trauma with acute respiratory failure. Surg Endosc. 2016;30(1):388–95.PubMedCrossRef
Metadata
Title
Facilitating ventilator weaning through rib fixation combined with video-assisted thoracoscopic surgery in severe blunt chest injury with acute respiratory failure
Authors
Tung-Ho Wu
Hsing-Lin Lin
Yi-Pin Chou
Fong-Dee Huang
Wen-Yen Huang
Yih-Wen Tarng
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-2755-4

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