Does Temporary Chest Wall Closure With or Without Chest Packing Improve Survival for Trauma Patients in Shock After Emergent Thoracotomy?

Lang, Jennifer L.; Gonzalez, Richard P.; Aldy, Kim; Carroll, Elizabeth A.; Eastman, Alexander L.; White, Cassandra Q.; Funk, Geoffrey; Phelan, Herb A.

doi:10.1097/ta.0b013e31820e89f1

Cited by 23 publications

(24 citation statements)

References 9 publications

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“…Packing has been advocated, but its use to control bleeding in the thoracic cavity is controversial (19-21). The temporary closing of the thorax is achieved by using a number of methods, including towel clip closure, skin only closure with or without packing the chest wall, and temporary dressings such as the Bogota bag (22-24). …”

Section: Introductionmentioning

confidence: 99%

Damage-control techniques in the management of severe lung trauma

García

Martı́nez

Rodríguez

et al. 2015

Journal of Trauma and Acute Care Surgery

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Background Damage Control (DC) has improved survival from severe abdominal and extremities injuries. The data on the surgical strategies and outcomes in patients managed with DC for severe thoracic injuries is scarce. Methods Retrospective review of the patients treated with DC for thoracic/pulmonary complex trauma at two level I trauma centers from 2006 to 2010. Subjects 14 and older, were included. Demographics, trauma characteristics, surgical techniques, and resuscitation strategies were reviewed. Results A total of 840 trauma thoracotomies were performed. Damage control thoracotomy (DCT) was done in 31 (3.7%). Pulmonary trauma was found in 25 of them. The median age was 28 (IQR 20–34) years, Revised Trauma Score was 7.11, (IQR 5.44–7.55), and Injury Severity Score was 26 (IQR 25–41). Nineteen patients had gunshot-wounds, four stab-wounds and two blunt trauma. Pulmonary trauma was managed by pneumorrhaphy in three cases, tractotomy in 12, wedge resection in one and packing as primary treatment in 8. Clamping of the pulmonary hilum was used as a last resource in 7 cases. Five patients returned to the ICU with the pulmonary hilum occluded by a vascular clamp or an en masse ligature. These patients underwent a deferred resection within 16 to 90 hours after the initial DCT. Four of them survived. Bleeding from other intra-thoracic sources was found in 20 cases: major vessels in nine, heart in three, and thoracic wall in nine. DCT mortality in pulmonary trauma was 6/25, (24%) due to coagulopathy or persistent bleeding in five cases and to multiorgan failure in one. Conclusion This series describes our experience with DCT in severe lung trauma. We describe pulmonary hilum clamping and deferred lung resection as a viable surgical alternative for major pulmonary injuries, and the use of packing as a definitive method for hemorrhage control.

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Section: Introductionmentioning

confidence: 99%

Damage-control techniques in the management of severe lung trauma

García

Martı́nez

Rodríguez

et al. 2015

Journal of Trauma and Acute Care Surgery

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“…This approach comprises (1) abbreviated surgery to rapidly control hemorrhage and contamination, (2) restoration of patient's physiology in the ICU, and (3) subsequent definitive surgery [6]. Recently, the use of DCS has been expanded from abdominal injuries to thoracic injuries; however, none of the studies using DCS principles in thoracic injuries demonstrated significant improvement in survival [7,8,10]. The techniques described in DCS for thoracic injuries include cardiac stapling [13], pulmonary tractotomy [7], packing [10], and temporary chest wall closure [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…The techniques described in DCS for thoracic injuries include cardiac stapling [13], pulmonary tractotomy [7], packing [10], and temporary chest wall closure [8][9][10]. Temporary chest wall closure methods described in the literature are (1) skin closure only, (2) en masse closure of chest wall (to decrease the bleeding from the chest wall), and (3) silastic sheet or "Bogota bag" closure (to avoid thoracic compartment syndrome) [7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…Packing of the thoracic cavity, unlike abdominal packing, cannot be liberally employed without causing adverse effects on cardiopulmonary physiology because of increased intrathoracic pressure [6]. However, when packing is used with temporary chest closure, the airway pressure may not be increased significantly [10].…”

Section: Discussionmentioning

confidence: 99%

“…Since the early 1980s, "damage control surgery" (DCS) has been widely accepted in management of severely injured patients, resulting in improved outcomes [5,6]. However, few investigators have described DCS techniques in thoracic injuries, particularly in cardiac injuries [7][8][9][10]. We report a case in a patient with blunt cardiac rupture detected 24 hours after the injury who developed hypothermia and coagulopathy during a surgical repair.…”

mentioning

confidence: 99%

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Damage control surgery in blunt cardiac injury

et al. 2014

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Background: Blunt cardiac injury (BCI) is a rare, but life threatening injury. The treatment of BCI is surgical repair. However, in a BCI patient with hypothermia, acidosis, and coagulopathy, an attempt to control the bleeding completely by surgery alone may not be successful. Damage control principles should be used in this situation. Objective: To study a BCI patient who underwent a successful operation using damage control principles. Methods: We reviewed and analyzed the patient's chart, operative notes and follow up visit records. Review of the literature regarding the issue was also conducted. Results: We report the case of a patient with BCI who developed hypothermia and coagulopathy during surgery. Abbreviated surgical repair was performed with a right pleuropericardial window created to avoid blood accumulation in the pericardial sac. Subsequent aggressive resuscitation was performed in the intensive care unit. We accepted ongoing bleeding through the right chest tubes while correction of hypothermia and coagulopathy was undertaken. The bleeding was gradually stopped once the patient's physiology was restored. Although the patient developed a retained right hemothorax requiring subsequent video-assisted thoracoscopic surgery on the third postoperative week, he recovered uneventfully and was discharged on postoperative day 36. Conclusion:In patients with BCI who develop coagulopathy during surgery, terminating the operation quickly and creating a pleuropericardial window is a possible bailout solution because this can prevent postoperative cardiac tamponade without leaving the chest open. Continue bleeding from the chest tubes is acceptable provided that adequate resuscitation to correct coagulopathy is underway.

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Travel and Transport

Berndtson¹,

Doucet²

2020

Thoracic Surgery for the Acute Care Surgeon

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Does Temporary Chest Wall Closure With or Without Chest Packing Improve Survival for Trauma Patients in Shock After Emergent Thoracotomy?

Cited by 23 publications

References 9 publications

Damage-control techniques in the management of severe lung trauma

Damage-control techniques in the management of severe lung trauma

Damage control surgery in blunt cardiac injury

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