Video-assisted thoracoscopy in the early diagnosis and management of post-traumatic pneumothorax and hemothorax

Abstract

Background: Blunt and penetrating chest traumas continue to be associated with a high mortality rate. The related morbidity rate is a also cause for concern because it may result in extended hospitalization and permanent disabilities. The aim of this study was to retrospectively review a series of consecutive patients treated for chest trauma between 1 January 2000 and 31 December 2005, focusing particularly on cases of pneumothorax and hemothorax. alone or in combination, and to critically assess the treatment protocol adopted.

Methods: Eighty-one patients with pneumothorax and/or hemothorax were subdivided into two groups. Group I (n = 46) comprised 36 patients with an Injury Severity Score (ISS) <9 and 10 patients with ISS from 9 to 15, all of whom were treated with chest tube alone. Group II (n = 35) included 34 patients with an ISS >9 who were treated with tube thoracostomy and VATS and 1 patient was treated by emergency thoracotomy.

Results: The time to complete recovery was virtually identical in both groups.

Conclusions: In light of their own experience and of reports in the literature confirming both the diagnostic and therapeutic efficacies of VATS in chest trauma with pneumothorax and/or hemothorax, the authors propose a treatment protocol prescribing its use 48 h from the traumatic event in all cases of uncontrolled air and/or blood loss. This protocol yielded excellent results, including an uneventful postoperative course, rapid resolution of the signs and symptoms of the chest problem, and no disabling sequelae (empyema and fibrothorax), as well as a relatively shorter hospital stay and hence lower costs than with conservative treatment.