ScotSTAR, Emergency Medical Retrieval Service, 180 Abbotsinch Road, Paisley, PA2 3RY, UK.
Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
Scand J Trauma Resusc Emerg Med. 2021 Dec 4;29(1):166. doi: 10.1186/s13049-021-00976-1.
Open thoracostomies have become the standard of care in pre-hospital critical care in patients with chest injuries receiving positive pressure ventilation. The procedure has embedded itself as a rapid method to decompress air or fluid in the chest cavity since its original description in 1995, with a complication rate equal to or better than the out-of-hospital insertion of indwelling pleural catheters. A literature review was performed to explore potential negative implications of open thoracostomies and discuss its role in mechanically ventilated patients without clinical features of pneumothorax.
A rapid review of key healthcare databases showed a significant rate of complications associated with pre-hospital open thoracostomies. Of 352 thoracostomies included in the final analysis, 10.6% (n = 38) led to complications of which most were related to operator error or infection (n = 26). Pneumothoraces were missed in 2.2% (n = 8) of all cases.
There is an appreciable complication rate associated with pre-hospital open thoracostomy. Based on a risk/benefit decision for individual patients, it may be appropriate to withhold intervention in the absence of clinical features, but consideration must be given to the environment where the patient will be monitored during care and transfer. Chest ultrasound can be an effective assessment adjunct to rule in pneumothorax, and may have a role in mitigating the rate of missed cases.
开放性胸廓切开术已成为接受正压通气的胸部创伤患者在院前重症监护中的标准治疗方法。自 1995 年首次描述以来，该手术已成为一种快速减压胸腔内空气或液体的方法，其并发症发生率与院外留置胸腔导管相当或更好。进行了文献回顾，以探讨开放性胸廓切开术的潜在负面影响，并讨论其在无气胸临床特征的机械通气患者中的作用。
对主要医疗保健数据库的快速审查显示，与院前开放性胸廓切开术相关的并发症发生率很高。在最终分析中纳入的 352 例胸廓切开术中，10.6%（n=38）导致并发症，其中大多数与操作人员错误或感染有关（n=26）。所有病例中有 2.2%（n=8）漏诊气胸。
院前开放性胸廓切开术存在相当高的并发症发生率。基于对个体患者的风险/获益决策，在缺乏临床特征的情况下，可能适合不进行干预，但必须考虑到患者在护理和转院期间所处的环境。床旁超声检查可以作为一种有效的气胸辅助评估手段，可能有助于降低漏诊率。
