Occult hemopneumothorax following chest trauma does not need a chest tube

I. Mahmood, Z. Tawfeek, S. Khoschnau, S. Nabir, A. Almadani, H. Al Thani, K. Maull, Rifat - Latifi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: The increasing use of thoracic computed tomography (CT) in trauma patients has led to the recognition of intrapleural blood and air that are not initially evident on admission plain chest X-ray, defining the presence of occult hemopneumothorax. The clinical significance of occult hemopneumothorax, specifically the role of the tube thoracostomy, is not clearly defined. Objective: To identify those patients with occult hemopneumothorax who can be safely managed without chest tube insertion. Design: Prospective observational study. Methods: During the recent 24 month period ending July 2010, comprehensive data on trauma patients with occult hemopneumothorax were recorded to determine whether tube thoracostomy was needed and, if not, to define the consequences of nondrainage. Pneumothorax and hemothorax were quantified by computed tomography (CT) measurement. Data included demographics, injury mechanism and severity, chest injuries, need for mechanical ventilation, indications for tube thoracostomy, hospital length of stay, complications and outcome. Results: There were 73 patients with hemopenumothorax identified on CT scan in our trauma registry. Tube thoracostomy was successfully avoided in 60 patients (83 %). Indications for chest tube placement in 13 (17 %) of patients included X-ray evidence of hemothorax progression (10), respiratory compromise with oxygen desaturation (2). Mechanical ventilation was required in 19 patients, five of them required chest tube insertion, and six developed ventilator associated pneumonia, while there were no cases of empyema. There was one death due to severe head injury. Conclusions: Occult hemopneumothorax can be successfully managed without tube thoracostomy in most cases. Patients with a high ISS score, need for mechanical ventilation, and CT-detected blood collection measuring >1. 5 cm increased the likelihood of need for tube thoracostomy. The size of the pneumothorax did not appear to be significant in determining the need for tube thoracostomy.

Original languageEnglish (US)
Pages (from-to)43-46
Number of pages4
JournalEuropean Journal of Trauma and Emergency Surgery
Volume39
Issue number1
DOIs
StatePublished - 2013
Externally publishedYes

Fingerprint

Hemopneumothorax
Chest Tubes
Thoracostomy
Thorax
Wounds and Injuries
Tomography
Artificial Respiration
Hemothorax
Pneumothorax
Length of Stay
X-Rays
Ventilator-Associated Pneumonia
Thoracic Injuries
Empyema
Injury Severity Score
Craniocerebral Trauma
Observational Studies
Registries
Air
Demography

Keywords

  • Chest trauma
  • Chest tube
  • Occult hemothorax
  • Occult pneumothorax

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine
  • Emergency Medicine

Cite this

Occult hemopneumothorax following chest trauma does not need a chest tube. / Mahmood, I.; Tawfeek, Z.; Khoschnau, S.; Nabir, S.; Almadani, A.; Al Thani, H.; Maull, K.; Latifi, Rifat -.

In: European Journal of Trauma and Emergency Surgery, Vol. 39, No. 1, 2013, p. 43-46.

Research output: Contribution to journalArticle

Mahmood, I, Tawfeek, Z, Khoschnau, S, Nabir, S, Almadani, A, Al Thani, H, Maull, K & Latifi, R 2013, 'Occult hemopneumothorax following chest trauma does not need a chest tube', European Journal of Trauma and Emergency Surgery, vol. 39, no. 1, pp. 43-46. https://doi.org/10.1007/s00068-012-0210-1
Mahmood, I. ; Tawfeek, Z. ; Khoschnau, S. ; Nabir, S. ; Almadani, A. ; Al Thani, H. ; Maull, K. ; Latifi, Rifat -. / Occult hemopneumothorax following chest trauma does not need a chest tube. In: European Journal of Trauma and Emergency Surgery. 2013 ; Vol. 39, No. 1. pp. 43-46.
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AU - Tawfeek, Z.

AU - Khoschnau, S.

AU - Nabir, S.

AU - Almadani, A.

AU - Al Thani, H.

AU - Maull, K.

AU - Latifi, Rifat -

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AB - Background: The increasing use of thoracic computed tomography (CT) in trauma patients has led to the recognition of intrapleural blood and air that are not initially evident on admission plain chest X-ray, defining the presence of occult hemopneumothorax. The clinical significance of occult hemopneumothorax, specifically the role of the tube thoracostomy, is not clearly defined. Objective: To identify those patients with occult hemopneumothorax who can be safely managed without chest tube insertion. Design: Prospective observational study. Methods: During the recent 24 month period ending July 2010, comprehensive data on trauma patients with occult hemopneumothorax were recorded to determine whether tube thoracostomy was needed and, if not, to define the consequences of nondrainage. Pneumothorax and hemothorax were quantified by computed tomography (CT) measurement. Data included demographics, injury mechanism and severity, chest injuries, need for mechanical ventilation, indications for tube thoracostomy, hospital length of stay, complications and outcome. Results: There were 73 patients with hemopenumothorax identified on CT scan in our trauma registry. Tube thoracostomy was successfully avoided in 60 patients (83 %). Indications for chest tube placement in 13 (17 %) of patients included X-ray evidence of hemothorax progression (10), respiratory compromise with oxygen desaturation (2). Mechanical ventilation was required in 19 patients, five of them required chest tube insertion, and six developed ventilator associated pneumonia, while there were no cases of empyema. There was one death due to severe head injury. Conclusions: Occult hemopneumothorax can be successfully managed without tube thoracostomy in most cases. Patients with a high ISS score, need for mechanical ventilation, and CT-detected blood collection measuring >1. 5 cm increased the likelihood of need for tube thoracostomy. The size of the pneumothorax did not appear to be significant in determining the need for tube thoracostomy.

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KW - Occult pneumothorax

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