Ramiro Manzano-Nunez1,2, Julian Chica3,4, Alexandra Gómez3, Maria P Naranjo3, Harold Chaves5, Luis E Muñoz5, Javier E Rengifo6, Isabella Caicedo-Holguin7, Juan C Puyana8, Alberto F García4,5. 1. Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia. ramiro.manzano@fvl.org.co. 2. Department of Surgery, Fundacion Valle del Lili, Cali, Colombia. ramiro.manzano@fvl.org.co. 3. Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia. 4. Department of Surgery, Fundacion Valle del Lili, Cali, Colombia. 5. Department of Surgery, Universidad del Valle, Cali, Colombia. 6. Department of Radiology, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia. 7. Facultad de Medicina, Universidad del Rosario, Bogotá, Colombia. 8. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Abstract
PURPOSE: Although Damage Control Thoracic Surgery (DCTS) has become a provocative alternative to treat patients with chest injuries who are critically ill and physiologically depleted, the management approaches of chest-packing and the measurement of clinically relevant outcomes are not well established. In this paper, we systematically reviewed the available knowledge and evidence about intra-thoracic packing during DCTS for trauma patients. We furthermore inform on the management approaches, surgical strategies, and mortality associated with this intervention. METHODS: We identified articles in MEDLINE and SCOPUS. We reviewed all studies that included trauma patients with chest injuries and managed with intrathoracic packing during DCTS. Studies were eligible if the use of intrathoracic packing in trauma populations was reported. RESULTS: We identified 14 studies with a total of 211 patients. Overall, intrathoracic packing was used in 131 trauma patients. Packing was most commonly used to arrest persistent coagulopathic bleeding or oozing either from raw surfaces or repaired structures and in conjunction with other operative techniques. Pneumonectomy was a deadly intervention; however, one study reported survivors when pneumonectomy was deferred. CONCLUSION: Packing is a feasible, reliable and potentially effective complementary method for hemorrhage control. Therefore, we recommend that packing can be used liberally as a complement to rapid lung-sparing techniques.
PURPOSE: Although Damage Control Thoracic Surgery (DCTS) has become a provocative alternative to treat patients with chest injuries who are critically ill and physiologically depleted, the management approaches of chest-packing and the measurement of clinically relevant outcomes are not well established. In this paper, we systematically reviewed the available knowledge and evidence about intra-thoracic packing during DCTS for traumapatients. We furthermore inform on the management approaches, surgical strategies, and mortality associated with this intervention. METHODS: We identified articles in MEDLINE and SCOPUS. We reviewed all studies that included traumapatients with chest injuries and managed with intrathoracic packing during DCTS. Studies were eligible if the use of intrathoracic packing in trauma populations was reported. RESULTS: We identified 14 studies with a total of 211 patients. Overall, intrathoracic packing was used in 131 traumapatients. Packing was most commonly used to arrest persistent coagulopathic bleeding or oozing either from raw surfaces or repaired structures and in conjunction with other operative techniques. Pneumonectomy was a deadly intervention; however, one study reported survivors when pneumonectomy was deferred. CONCLUSION: Packing is a feasible, reliable and potentially effective complementary method for hemorrhage control. Therefore, we recommend that packing can be used liberally as a complement to rapid lung-sparing techniques.
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