Document Detail


Timing, safety, and efficacy of thoracoscopic evacuation of undrained post-traumatic hemothorax.
MedLine Citation:
PMID:  11768822     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Residual post-traumatic hemothorax (RPTH) occurs in 3 to 8 per cent of patients with tube thoracostomy and may cause serious infectious complications. Surgical evacuation is recommended, and thoracoscopic evacuation (THEVA) tends to replace open thoracotomy for this purpose. The objective of this study is to evaluate the optimal timing, safety, and efficacy of THEVA. Over 5 years patients with tube thoracostomy for trauma who had unresolved opacities on plain chest radiograph were evaluated by CT. If the residual fluid volume was estimated to be more than 500 mL3 on CT the patients were offered THEVA. Unstable patients were excluded. A score ranging from one (easy) to three (difficult) was used to grade the difficulty of the operation according to the attending surgeon's perception. Of 1728 chest trauma patients 143 (8%) were evaluated by CT for persistent opacity on plain film, 31 (1.8%) were found to have RPTH, and 24 (1.4%) were eventually taken for THEVA at 3.5+/-2 days after admission. Low oxygen saturation (less than 94%) was found in 58 per cent of patients before THEVA but in only 25 per cent after THEVA (P = 0.02). The majority of chest tubes (75%) were removed within 4 days of the operation. Two patients required conversion to thoracotomy. THEVA done within 3 days of admission was associated with a lower operative difficulty score, shorter hospital stay, and a trend toward shorter intraoperative time compared with THEVA done after 3 days of admission. All patients had effective resolution of their radiographic opacities after THEVA. Three patients developed a complication (urinary tract infection, pneumonia, and persistent air leak). We conclude that patients with significant RPTH and without major physiologic compromise are appropriate candidates for THEVA. The procedure is safe, evacuates PRTH effectively, and improves the respiratory function of affected patients. Ideally it should be performed within 3 days of admission.
Authors:
P Vassiliu; G C Velmahos; K G Toutouzas
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  67     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  2001 Dec 
Date Detail:
Created Date:  2001-12-21     Completed Date:  2002-01-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1165-9     Citation Subset:  IM    
Affiliation:
Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Hemothorax / etiology,  physiopathology,  radiography,  surgery*
Humans
Male
Respiratory Mechanics
Thoracic Injuries / complications*,  surgery
Thoracoscopy*
Thoracostomy
Time Factors
Tomography, X-Ray Computed

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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