Prevention of Infection in War Chest Injuries

Abstract

Infection is a major complication of military chest injuries. In a series of 142 wounded, infectious complications occurred in 7 (4.9%). Factors influencing the incidence of infection are evaluated. In this group of injuries, 81 patients were admitted soon after wounding. The intrathoracic damage was severe, due to penetration of metallic fragment. The hemothorax was treated by immediate intercostal drainage. Immediate thoracotomy was performed in 10 patients and late thoractomy in 15. One patient developed a lung abscess and 5 patients had infection following thoracotomy (7.4%). Another 61 wounded patients had been first managed in a forward hospital, including three with thoractomy for massive bleeding. Two, not in a forward hospital, had a bullet removed from the lung. Upon admission to this hospital, intercostal drains were inserted when needed and four patients underwent thoracotomy. Larger wounds were debrided in 24 patients. Late thoracotomy was perfromed in seven. Chronic empyema developed in one patient after pneumonectomy performed at the field hospital, resulting in a resuscitation or infection rate of less than 2%. Factors contributing to a low infection rate were: early drainage of hemothoraces and wide debridement of larger wounds with delayed closure and avoidance of thoracotomy as primary treatment. Resection of lung tissue was avoided. Thoraco-abdominal injuries were treated separately. The clotted hemothorax was immediately evacuated. Prolonged antibiotic therapy was usually indicated.

Residual Hemothorax after Chest Tube Placement Correlates with Increased Risk of Empyema Following Traumatic Injury

“…Empyema in this setting occurs relatively early in the hospitalization, as opposed to trauma patients who develop empyema as a complication of ventilator-associated pneumonia (11). A number of risk factors have been identified, but there are conflicting data in the literature (1,2,5,(11)(12)(13)(14)(15)(16)(17)(18). The routine use and duration of antibiotics that provide Gram-positive coverage has been vociferously debated (1)(2)(3)(4)6,12,13).…”

“…A number of risk factors have been identified, but there are conflicting data in the literature (1,2,5,(11)(12)(13)(14)(15)(16)(17)(18). The routine use and duration of antibiotics that provide Gram-positive coverage has been vociferously debated (1)(2)(3)(4)6,12,13). Reviewing the available literature in 2000, the Eastern Association for the Surgery of Trauma noted that 24 h coverage appeared to be equivalent to longer periods, and the general consensus is that most surgeons believe that at least one dose is better than none (3).…”

Transsternal transpericardial closure of a postpneumonectomy bronchial fistula in a patient who underwent pneumonectomy because of a war injury

“…2,3 Postpneumonectomy empyema is one of the rarest complications of military chest injuries, as reported in a series of 142 patients with wounds of the chest, among whom only one presented with empyema. 4 However, mortality associated with emergent pneumonectomy for hilar injuries is reported to be 50%-100%. 5 The development of bronchopleural fi stula has been attributed to several intraoperative factors, such as rightsided pneumonectomy, bronchial stump coverage, and bronchial stump length.…”

Surgical progress 1975

“…Romanoff (1975), for example, reports 142 cases of wounds of the chest treated in Israel during the 6 day war of 1967 and the Yom Kippur War, many of a massive nature, in which the total infection rate was a remarkable 4.9 % (seven patients). This is in contrast to World War II infection rate in such injuries of around 50%.…”