OBJECTIVE: Severe chest injuries are still associated with significant morbidity and mortality. This systematic review assesses the early operative management of severe chest trauma in multi injured patients with special regard to the priority of the operative therapy. METHODS: Clinical trials were systematically sought and collected (MEDLINE, Cochrane and hand searches). Of 618 abstracts, 46 articles were selected for detailed appraisal and were classified into evidence levels (1 to 5 according to the Oxford system). RESULTS: Penetrating chest injuries in haemodynamically instable patients require emergency operative therapy. A thoracotomy is also indicated in excessive chest tube output (>1500 ml). An aortic rupture can be treated either by open suture or-in borderline patients-by endovascular stenting. In selected haemodynamically stable patients delayed treatment is also possible. Lesions of the tracheobronchial system should be treated urgently with primary surgical repair. Diaphragmatic ruptures should be closed urgently. Surgical stabilisation of rib fractures with an associated flail chest reduces the ventilator days and the length of intensive care unit stay. CONCLUSION: A large part of early surgery for chest injuries is justified because it averts immediate threats to life (level 1c evidence). No randomised and only a few controlled trials have examined the relative value of the different surgical options so far. Long-term data are lacking especially on the safety of endovascular stenting.
OBJECTIVE: Severe chest injuries are still associated with significant morbidity and mortality. This systematic review assesses the early operative management of severe chest trauma in multi injured patients with special regard to the priority of the operative therapy. METHODS: Clinical trials were systematically sought and collected (MEDLINE, Cochrane and hand searches). Of 618 abstracts, 46 articles were selected for detailed appraisal and were classified into evidence levels (1 to 5 according to the Oxford system). RESULTS: Penetrating chest injuries in haemodynamically instable patients require emergency operative therapy. A thoracotomy is also indicated in excessive chest tube output (>1500 ml). An aortic rupture can be treated either by open suture or-in borderline patients-by endovascular stenting. In selected haemodynamically stable patients delayed treatment is also possible. Lesions of the tracheobronchial system should be treated urgently with primary surgical repair. Diaphragmatic ruptures should be closed urgently. Surgical stabilisation of rib fractures with an associated flail chest reduces the ventilator days and the length of intensive care unit stay. CONCLUSION: A large part of early surgery for chest injuries is justified because it averts immediate threats to life (level 1c evidence). No randomised and only a few controlled trials have examined the relative value of the different surgical options so far. Long-term data are lacking especially on the safety of endovascular stenting.
Authors: T C Fabian; J D Richardson; M A Croce; J S Smith; G Rodman; P A Kearney; W Flynn; A L Ney; J B Cone; F A Luchette; D H Wisner; D J Scholten; B L Beaver; A K Conn; R Coscia; D B Hoyt; J A Morris; J D Harviel; A B Peitzman; R P Bynoe; D L Diamond; M Wall; J D Gates; J A Asensio; B L Enderson Journal: J Trauma Date: 1997-03
Authors: V Mann; S Mann; G Szalay; M Hirschburger; R Röhrig; C Dictus; T Wurmb; M A Weigand; M Bernhard Journal: Anaesthesist Date: 2010-08 Impact factor: 1.041
Authors: Francisco Cury; André Luciano Baitello; Rodrigo Florêncio Echeverria; Paulo César Espada; José Maria Pereira de Godoy Journal: Ann Thorac Med Date: 2009-01 Impact factor: 2.219
Authors: Aristotelis P Mitsos; Jonathan Chantler; Evangelos Konstantinou; Theofanis Fotis; Ekaterini Lambrinou; Ramon Uberoi; Richard Stacey; James V Byrne Journal: Cases J Date: 2009-06-05