Mozer-Glassberg Yael, Radomislensky Irina, Benov Avi, Almog Ofer
Institute of Pediatric Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Transfusion. 2025 May;65 Suppl 1(Suppl 1):S98-S102. doi: 10.1111/trf.18198. Epub 2025 Mar 25.
Trauma is a leading cause of preventable death, with a significant portion of trauma deaths occurring in the prehospital setting. Interventions such as chest drainage may play a critical role in managing life-threatening conditions but face challenges due to poorly defined indications and reliance on anecdotal evidence rather than rigorous studies. Among chest drainage techniques, finger thoracostomy (FT) is a well-described, but controversial, method for decompressing the pleural cavity in emergencies like tension pneumothorax or hemothorax. Despite its simplicity and minimal equipment requirements, FT carries risks, including bleeding, infection, organ injury, temporary effects, and procedural failure.
This study examines eight FT procedures performed by Israel Defense Forces providers during the 2023-2024 "Swords of Iron" War in Gaza.
All patients sustained severe penetrating injuries, with mixed outcomes. One case highlighted severe complications, including infection and empyema weeks later. Additionally, challenges in maintaining up-to-date knowledge and adherence to protocols among reservists led to unauthorized FT procedures, emphasizing the dangers of improvisation without evidence.
Our findings, coupled with limited evidence for FT's effectiveness in prehospital settings, raise questions about its appropriateness in trauma care. These concerns highlight the critical importance of adhering to validated and evidence-based protocols in all aspects of medical practice. Deviating from such protocols not only introduces unnecessary risks but also undermines the standardization essential for optimal patient care. Further research is needed to clarify the role, if any, of FT in prehospital trauma management.
创伤是可预防死亡的主要原因，很大一部分创伤死亡发生在院前环境中。胸腔引流等干预措施在处理危及生命的情况时可能发挥关键作用，但由于适应症定义不明确以及依赖轶事证据而非严格研究，面临诸多挑战。在胸腔引流技术中，手指胸廓造口术（FT）是一种描述详尽但存在争议的方法，用于在张力性气胸或血胸等紧急情况下对胸腔进行减压。尽管FT操作简单且设备要求极低，但仍存在风险，包括出血、感染、器官损伤、暂时影响及操作失败。
本研究考察了以色列国防军医护人员在2023 - 2024年加沙“铁剑”战争期间实施的8例手指胸廓造口术。
所有患者均遭受严重穿透伤，结果各异。1例出现严重并发症，包括数周后的感染和脓胸。此外，预备役人员在保持最新知识和遵守规程方面存在挑战，导致出现未经授权的手指胸廓造口术操作，凸显了无证据即兴操作的危险性。
我们的研究结果，再加上手指胸廓造口术在院前环境中有效性的证据有限，引发了对其在创伤护理中适用性的质疑。这些担忧凸显了在医疗实践的各个方面遵循经过验证的循证规程的至关重要性。偏离此类规程不仅会带来不必要的风险，还会破坏实现最佳患者护理所必需的标准化。需要进一步研究来阐明手指胸廓造口术在院前创伤管理中的作用（若有）。
