Management of traumatic pneumothorax in isolated blunt chest trauma

Abstract

Objectives: Pneumothorax is an important complication of blunt chest trauma. The aim of this study was to report our experience in treatment strategy and outcomes of traumatic pneumothorax. Methods: A total of 78 patients who developed pneumothorax due to isolated blunt chest trauma were evaluated in terms of age, gender, size of pneumothorax, treatment methods, complications and length of hospital stay. The size of pneumothorax was calculated with computer-aided volumetry. Results: Tube thoracostomy was performed for 48 patients while observation was undertaken for 30 cases. Chest tubes were inserted in 6 patients after 24 hours following the traumatic event. A total of 8 patients who developed prolonged air leakage and hemothorax as complications underwent video-assisted thoracoscopic surgery. None of the patients developed any mortality or morbidity. Conclusions: Traumatic pneumothorax demands prompt diagnosis and treatment. Monitoring all patients even with small sizes of traumatic pneumothorax for at least 24 hours onset of their initial assessment and applying chest tubes for cases who have pneumothorax larger than 50% at first examination should be an appropriate modality for treatment. Moreover, the minimally invasive approach of video-assisted thoracoscopic surgery benefits to overcome the complications of thoracic trauma.

Extensive Epidemiological Study of Traumatic Pneumothorax in Saudi Arabia’s Population

“…The study's demographic finding is close to other reports [3,4] indicating that males are likely to have more traumatic pneumothorax because they are more involved and mobile; thus, increasing trauma risk. However, in other populations such as Murat et al study's targeting group, no major difference in the injured gender [5]. The reason is that in the SA, the males are eligible for driving.…”

“…Traumatic pneumothorax is pleural air caused by trauma and can be a partial or complete collapse of the lung. Traumatic pneumothorax can result from penetrating or blunt lung injuries [5]. Thoracic injury accounts for 25% of all mortal injuries and is the commonest intra-thoracic blunt chest injury manifestation, which occurs in 40-50% of patients with thoracic injury [6].…”

Can patients with traumatic pneumothorax be managed without insertion of an intercostal drain?

“…Saricam et al. report 3/78 patients who had recurrent pneumothorax on repeat CXR at 10 days, 16 with no clinical signs of pneumothorax. No other studies reported further morbidity, mortality or complications in conservatively managed patients.…”

“…Saricam et al. 16 found 17% of patients with pneumothorax <10% of the thoracic volume required a chest drain following initial conservative management. In Eddine et al.…”