Mahmood Ismail, Younis Basil, Ahmed Khalid, Mustafa Fuad, El-Menyar Ayman, Alabdallat Mohammad, Parchani Ashok, Peralta Ruben, Nabir Syed, Ahmed Nadeem, Al-Thani Hassan
Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar.
Department of Radiology, Hamad General Hospital, Doha, Qatar.
Qatar Med J. 2020 Mar 16;2020(1):10. doi: 10.5339/qmj.2020.10. eCollection 2020.
We aimed to assess the management and outcome of occult pneumothorax and to determine the factors associated with failure of observational management in patients with blunt chest trauma (BCT). Patients with BCT were retrospectively identified from the trauma database over 4 years. Data were analyzed and compared on the basis of initial management (conservative vs. tube thoracostomy). Across the study period, 1928 patients were admitted with BCT, of which 150 (7.8%) patients were found to have occult pneumothorax. The mean patient age was 32.8 ± 13.7 years, and the majority were male (86.7%). Positive-pressure ventilation (PPV) was required in 32 patients, and bilateral occult pneumothorax was seen in 25 patients. In 85.3% (n = 128) of cases, occult pneumothorax was managed conservatively, whereas 14.7% (n = 22) underwent tube thoracostomy. Five patients had failed observational treatment requiring delayed tube thoracostomy. Pneumonia was reported in 12.8% of cases. Compared with those who were treated conservatively, patients who underwent tube thoracostomy had thicker pneumothoraxes and a higher rate of lung contusion, rib fracture, pneumonia, prolonged ventilatory days, and prolonged hospital length of stay. Overall mortality was 4.0%. The deceased had more polytrauma and were treated conservatively without a chest tube. Patients who failed conservative management had a higher frequency of lung contusion, greater pneumothorax thickness, higher Injury Severity Scores (ISS), and required more PPV. Occult pneumothorax is not uncommon in BCT and can be successfully managed conservatively with a close clinical follow-up. Intervention should be limited to patients who have an increase in size of the pneumothorax on follow-up or become symptomatic under observation. Patients who fail conservative management may have a greater pneumothorax thickness and higher ISS. However, large prospective studies are warranted to support these findings and to establish the institutional guidelines for the management of occult pneumothorax.
我们旨在评估隐匿性气胸的处理方式及预后，并确定钝性胸部创伤（BCT）患者观察性处理失败的相关因素。通过回顾性分析4年期间创伤数据库中的数据，确定BCT患者。根据初始处理方式（保守治疗与胸腔闭式引流）对数据进行分析和比较。在研究期间，1928例患者因BCT入院，其中150例（7.8%）被发现患有隐匿性气胸。患者平均年龄为32.8±13.7岁，大多数为男性（86.7%）。32例患者需要正压通气（PPV），25例患者出现双侧隐匿性气胸。85.3%（n=128）的病例采用保守治疗，14.7%（n=22）接受了胸腔闭式引流。5例患者观察性治疗失败，需要延迟胸腔闭式引流。12.8%的病例报告有肺炎。与保守治疗的患者相比，接受胸腔闭式引流的患者气胸更厚，肺挫伤、肋骨骨折、肺炎、机械通气时间延长和住院时间延长的发生率更高。总体死亡率为4.0%。死亡患者多发伤更多，接受保守治疗且未放置胸管。保守治疗失败的患者肺挫伤频率更高，气胸厚度更大，损伤严重度评分（ISS）更高，需要更多的PPV。隐匿性气胸在BCT中并不少见，通过密切的临床随访可以成功地进行保守治疗。干预应仅限于随访期间气胸增大或观察期间出现症状的患者。保守治疗失败的患者可能气胸厚度更大，ISS更高。然而，需要大型前瞻性研究来支持这些发现，并建立隐匿性气胸处理的机构指南。
