Evolución y complicaciones del traumatismo torácico / Evolution and Complications of Chest Trauma

Objetivo: Describir las características clínicas y los factores de riesgo de los pacientes con traumatismo torácico, y evaluar su relación en el desarrollo de complicaciones. Metodología: Estudio de tipo descriptivo, prospectivo y analítico de una cohorte de pacientes con traumatismo torácico a los que se les hizo seguimiento durante un periodo de 30días. Se excluyeron pacientes con traumatismo craneoencefálico moderado a severo, fracturas de huesos largos, traumatismo abdominal, y pacientes que requirieron ventilación mecánica. Resultados: Un total 376 pacientes cumplieron criterios de inclusión, y de ellos 220 eran varones (58,5%). Las causas más frecuentes de traumatismo fueron las caídas (218 casos; 57,9%) y los accidentes de tráfico (57 casos; 15,1%). El tipo de traumatismo más frecuente fue la contusión costal (248 casos; 65,9%) y la fractura de un arco costal (61casos; 16,2%). Se observaron complicaciones en 43pacientes (11,4%), principalmente por hemotórax (13casos), neumotórax (9casos), neumonía (6casos) e insuficiencia renal aguda (4casos). De estos pacientes, 4fallecieron por neumonía y hemotórax. Treinta y tres pacientes (8,7%) fueron ingresados y 10 (2,6%) requirieron reingreso hospitalario. El riesgo de complicaciones aumenta significativamente en pacientes con más de 2 fracturas costales, en mayores de 85 años y en presencia de algunas comorbilidades como la EPOC y patologías que requieren anticoagulación. El riesgo de reingreso es mayor en pacientes con más de 60 años. Conclusiones: Los pacientes con traumatismo torácico que presentan algunas comorbilidades, son mayores de 85 años y tienen más de2 fracturas costales pueden presentar más complicaciones, y se deben considerar estos factores en su evaluación, manejo y seguimiento (AU)

Objective: To describe the clinical characteristics and risk factors of patients with chest trauma, and to evaluate their correlation with the development of complications. Methods: Descriptive, prospective and analytical study of a patient cohort with chest trauma who underwent follow-up for a period of 30days. Excluded from the study were those patients with moderate to severe traumatic brain injury, long-bone fractures, abdominal trauma and patients requiring mechanical ventilation. Results: A total of 376 patients met the inclusion criteria, 220 of whom were males (58.5%). The most frequent causes of trauma were falls (218 cases; 57.9%) and motor vehicle accidents (57 cases; 15.1%). The most frequent type of trauma was rib contusion (248 cases; 65.9%) and rib fractures (61 cases; 16.2%). Complications were observed in 43 patients (11.4%), mainly hemothorax (13 cases), pneumothorax (9 cases), pneumonia (6 cases) and acute renal failure (4 cases). Four patients died due to pneumonia and hemothorax. Thirty-three patients were hospitalized (8.7%) and 10 (2.6%) required later re-admittance. The risk for complications increased significantly in patients with more than 2 rib fractures, in those over the age of 85 and in the presence of certain comorbidities, such as COPD and pathologies requiring anticoagulation therapy. The risk for re-admittance is higher in patients over the age of 60. Conclusions: Patients with chest trauma who present certain comorbidities, are over the age of 85 and have more than 2 rib fractures may present more complications. These factors should be contemplated in the evaluation, management and follow-up of these subjects (AU)

Evolution and complications of chest trauma.

OBJECTIVE: To describe the clinical characteristics and risk factors of patients with chest trauma, and to evaluate their correlation with the development of complications. METHODS: Descriptive, prospective and analytical study of a patient cohort with chest trauma who underwent follow-up for a period of 30 days. Excluded from the study were those patients with moderate to severe traumatic brain injury, long-bone fractures, abdominal trauma and patients requiring mechanical ventilation. RESULTS: A total of 376 patients met the inclusion criteria, 220 of whom were males (58.5%). The most frequent causes of trauma were falls (218 cases; 57.9%) and motor vehicle accidents (57 cases; 15.1%). The most frequent type of trauma was rib contusion (248 cases; 65.9%) and rib fractures (61 cases; 16.2%). Complications were observed in 43 patients (11.4%), mainly hemothorax (13 cases), pneumothorax (9 cases), pneumonia (6 cases) and acute renal failure (4 cases). Four patients died due to pneumonia and hemothorax. Thirty-three patients were hospitalized (8.7%) and 10 (2.6%) required later re-admittance. The risk for complications increased significantly in patients with more than 2 rib fractures, in those over the age of 85 and in the presence of certain comorbidities, such as COPD and pathologies requiring anticoagulation therapy. The risk for re-admittance is higher in patients over the age of 60. CONCLUSIONS: Patients with chest trauma who present certain comorbidities, are over the age of 85 and have more than 2 rib fractures may present more complications. These factors should be contemplated in the evaluation, management and follow-up of these subjects.

Conservative management of postsurgical chylothorax with octreotide.

Postsurgical chylothorax after lung resection has an important associated rate of morbidity and mortality, and a large proportion of cases require re-exploration. The most desirable and least aggressive option is conservative treatment. The use of octreotide seems to be associated with a higher rate of resolution without the need for surgical intervention. We present 4 cases in which this drug showed excellent efficacy and minimal adverse effects in the resolution of postsurgical chylothorax.

Successful conservative management in iatrogenic tracheobronchial injury.

BACKGROUND: The aim of this study was to describe and to assess the effectiveness of conservative treatment as the chosen treatment for managing iatrogenic tracheobronchial injuries (ITBI). METHODS: Between January 1993 and December 2003, 33 tracheobronchial injuries were treated in our hospital. Eighteen (54.5%) were ITBI and 15 (45.5%) were traumatic noniatrogenic injuries. Of the ITBI patients, sex distribution was 15 (83%) females and 3 (17%) males with a mean age of 57.7 +/- 20.7 years (range, 17 to 88 years). Fifteen (83.3%) of the injuries were caused by orotracheal intubation and 3 (15.7%) by tracheotomy. The average diagnostic delay was 25.7 +/- 22.9 hours. The mean injury size was 2.83 +/- 1.02 cm (range, 1 to 4 cm). Nine (50%) injuries were located in the cervical trachea, 6 (33.3%) in the thoracic trachea, and 3 (16%) involved both trachea and main bronchi. Conservative treatment was chosen for 17 (94.4%) of the 18 cases. We performed surgical repair in only 1 case owing to progressive subcutaneous emphysema and increasing difficulty with mechanical ventilation. RESULTS: No complications arose from the use of conservative treatment. Four patients (22%) died in our hospital, 3 of these of non-ITBI-related causes. Mortality was not related to four variables: sex, diagnostic delay, location, or size of the ITBI. Fourteen of the 18 patients (77.7%) were discharged uneventfully, and the endoscopic and clinical follow-up examinations were satisfactory in all patients. CONCLUSIONS: Conservative treatment for ITBI is effective regardless of production, size, or site of the injuries. Surgical treatment is advisable in specific cases: rapid progression of subcutaneous and mediastinal emphysema, mediastinitis, and difficulty with mechanical ventilation.