Abstract
BackgroundSevere blunt chest injury sometimes induces acute respiratory failure (ARF), requiring ventilator use. We aimed to evaluate the effect of performing rib fixation with the addition of video-assisted thoracoscopic surgery (VATS) on patients with ARF caused by blunt thoracic injury with ventilator dependence.MethodsThis observational study prospectively enrolled patients with multiple bicortical rib fractures with hemothorax caused by severe blunt chest trauma. All patients received positive pressure mechanical ventilation within 24 h after trauma because of ARF. Some patients who received rib fixation with VATS were enrolled as group 1, and the others who received only VATS were designated as group 2. The length of ventilator use was the primary clinical outcome. Rates of pneumonia and length of hospital stay constituted secondary outcomes.ResultsA total of 61 patients were included in this study. The basic demographic characteristics between the two groups exhibited no statistical differences. All patients received operations within 6 days after trauma. The length of ventilator use was shorter in group 1 (3.19 ± 3.37 days vs. 8.05 ± 8.23, P = 0.002). The rate of pneumonia was higher in group 2 (38.1% vs. 75.0%, P = 0.005). The length of hospital stay was much shorter in group 1 (17.76 ± 8.38 days vs. 24.13 ± 9.80, P = 0.011).ConclusionRib fixation combined with VATS could shorten the length of ventilator use and reduce the pneumonia rate in patients with severe chest blunt injury with ARF. Therefore, this operation could shorten the overall length of hospital stay.
Highlights
Severe blunt chest trauma can cause multiple rib fractures accompanied by hemothorax or pneumothorax [1, 2] and lung contusions, compromising the facility for gas exchange in the lung parenchyma
All patients had acute respiratory failure (ARF) and received emergent endotracheal tube insertions and positive pressure ventilator support within 24 h after trauma. These patients all had pneumothorax and hemothorax, resulting in tube thoracostomy being performed in the emergency department (ED)
Twenty-one patients receiving rib fixation with video-assisted thoracoscopic surgery (VATS) were included in group 1, and the other 40 patients receiving VATS only belonged to group 2
Summary
Severe blunt chest trauma can cause multiple rib fractures accompanied by hemothorax or pneumothorax [1, 2] and lung contusions, compromising the facility for gas exchange in the lung parenchyma. Intubation with positive pressure ventilation is widely accepted as an initial treatment for ARF [3, 4]. This method can be rapidly applied to provide sufficient tissue oxygenation in patients with lung contusion as well as rib fracture, contributing to impaired gas exchange in the lungs. Severe blunt chest injury sometimes induces acute respiratory failure (ARF), requiring ventilator use. We aimed to evaluate the effect of performing rib fixation with the addition of video-assisted thoracoscopic surgery (VATS) on patients with ARF caused by blunt thoracic injury with ventilator dependence
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