Predictors of chest drainage complications in trauma patients

Cecília Araújo Mendes,Elcio Shiyoiti Hirano

doi:10.1590/0100-6991e-20181543

Abstract

to identify predictors of chest drainage complications in trauma patients attended at a University Hospital. we conducted a retrospective study of 68 patients submitted to thoracic drainage after trauma, in a one-year period. We analyzed gender, age, trauma mechanism, trauma indices, thoracic and associated lesions, environment in which the procedure was performed, drainage time, experience of the performer, complications and evolution. the mean age of the patients was 35 years and the male gender was the most prevalent (89%). Blunt trauma was the most frequent, with 67% of cases, and of these, 50% were due to traffic accidents. The mean TRISS (Trauma and Injury Severity Score) was 98, with a mortality rate of 1.4%. The most frequent thoracic and associated lesions were, respectively, rib fractures (51%) and abdominal trauma (32%). The mean drainage time was 6.93 days, being higher in patients under mechanical ventilation (p=0.0163). The complication rate was 26.5%, mainly poor drain positioning (11.77%). Hospital drainage was performed in 89% of cases by doctors in the first year of specialization. Thoracic drainage performed in prehospital care presented nine times more chances of complications (p=0.0015). the predictors of post-trauma complications for chest drainage were a procedure performed in an adverse site and mechanical ventilation. The high rate of complications demonstrates the importance of protocols of care with the thoracic drainage.

Highlights

Chest trauma is present in 10% to 15% of the traumatized, accounting for 25% of all deaths[1], mainly due to airway and ventilation compromise
This study aims to identify predictive factors related to the complications of thoracic drainage in trauma patients, correlating them with the literature
Accidents were the most frequent mechanism (40% of cases), male gender was the most prevalent (89% of cases), mean age was 31 years and associated lesions occurred in 36% of patients, with predominance of upper and lower limbs(19% of cases), followed by abdominal and craniocerebral trauma (13% and 8% of the cases, respectively)[12], This differs from our study, in which abdominal trauma was the lesion most associated with thoracic trauma (32 % of cases) and the most prevalent event was motorcycling

Summary

Introduction

Chest trauma is present in 10% to 15% of the traumatized, accounting for 25% of all deaths[1], mainly due to airway and ventilation compromise. Performed chest seal drainage is a safe procedure and about 80% of patients have adequate resolution[5,6]. Complications, when they occur, can be caused by two factors: a) technical, due to lack of knowledge of the thoracic anatomy, inadequate training, lack of experience or deficiency of supervision, when performed by a physician in training; and b) infectious, when the procedure is performed in an inappropriate environment or without due asepsis and antisepsis[7]

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