Abstract
The management of patients following the operative fixation of chest wall injuries can be as important to assuring a good clinical outcome as the actual surgery itself. Additionally, the appropriate management of patients who have been managed non-operatively is critical. In both circumstances, care focuses on three common principles: chest tube management, optimal analgesia and maintenance of pulmonary function (including spirometry, management of pneumonia and ventilation). This chapter will focus on these three aspects of care for the patient with a chest wall injury.
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References
Bilello JF, Davis JW, Lemaster DM. Occult traumatic hemothorax: when can sleeping dogs lie? Am J Surg. 2005;190(6):841–4. doi:10.1016/j.amjsurg.2005.05.053.
Mowery NT, Gunter OL, Collier BR, et al. Practice management guidelines for management of hemothorax and occult pneumothorax. J Trauma. 2011;70(2):510–8. doi:10.1097/TA.0b013e31820b5c31.
Tang ATM, Velissaris TJ, Weeden DF. An evidence-based approach to drainage of the pleural cavity: evaluation of best practice. J Eval Clin Pract. 2002;8(3):333–40. http://www.ncbi.nlm.nih.gov/pubmed/12164980. Accessed 1 Feb 2015.
Lesquen H De, Avaro J-P, Gust L, et al. Surgical management for the first 48 h following blunt chest trauma: state of the art (excluding vascular injuries). Interact Cardiovasc Thorac Surg. 2014:1–10. doi:10.1093/icvts/ivu397.
Ball CG, Kirkpatrick AW, Laupland KB, et al. Incidence, risk factors, and outcomes for occult pneumothoraces in victims of major trauma. J Trauma. 2005;59(4):917–24; discussion 924–5. http://www.ncbi.nlm.nih.gov/pubmed/16374282. Accessed 27 Jan 2015.
Brasel KJ, Stafford RE, Weigelt JA, Tenquist JE, Borgstrom DC. Treatment of occult pneumothoraces from blunt trauma. J Trauma. 1999;46(6):987–90; discussion 990–1. http://www.ncbi.nlm.nih.gov/pubmed/10372613. Accessed 1 Feb 2015.
Enderson BL, Abdalla R, Frame SB, Casey MT, Gould H, Maull KI. Tube thoracostomy for occult pneumothorax: a prospective randomized study of its use. J Trauma. 1993;35(5):726–9; discussion 729–30. http://www.ncbi.nlm.nih.gov/pubmed/8230337. Accessed 1 Feb 2015
Kirkpatrick AW, Rizoli S, Ouellet J-F, et al. Occult pneumothoraces in critical care: a prospective multicenter randomized controlled trial of pleural drainage for mechanically ventilated trauma patients with occult pneumothoraces. J Trauma Acute Care Surg. 2013;74(3):747–54; discussion 754–5. doi:10.1097/TA.0b013e3182827158.
Moore FO, Duane TM, Hu CKC, et al. Presumptive antibiotic use in tube thoracostomy for traumatic hemopneumothorax: an Eastern association for the surgery of trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S341–4. doi:10.1097/TA.0b013e31827018c7.
Bosman A, de Jong MB, Debeij J, van den Broek PJ, Schipper IB. Systematic review and meta-analysis of antibiotic prophylaxis to prevent infections from chest drains in blunt and penetrating thoracic injuries. Br J Surg. 2012;99(4):506–13. doi:10.1002/bjs.7744.
Reeb J, Falcoz P-E, Olland A, Massard G. Are daily routine chest radiographs necessary after pulmonary surgery in adult patients? Interact Cardiovasc Thorac Surg. 2013;17(6):995–8. doi:10.1093/icvts/ivt352.
Cerfolio RJ, Bryant AS. Daily chest roentgenograms are unnecessary in nonhypoxic patients who have undergone pulmonary resection by thoracotomy. Ann Thorac Surg. 2011;92(2):440–3. doi:10.1016/j.athoracsur.2011.04.002.
Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ. Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury. Can Respir J. 15(5):255–8. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2679547&tool=pmcentrez&rendertype=abstract. Accessed 2 Feb 2015.
Meyer DM, Jessen ME, Wait MA, Estrera AS. Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial. Ann Thorac Surg. 1997;64(5):1396–400; discussion 1400–1. doi:10.1016/S0003-4975(97)00899-0.
Utter GH. The rate of pleural fluid drainage as a criterion for the timing of chest tube removal: theoretical and practical considerations. Ann Thorac Surg. 2013;96(6):2262–7. doi:10.1016/j.athoracsur.2013.07.055.
Martino K, Merrit S, Boyakye K, et al. Prospective randomized trial of thoracostomy removal algorithms. J Trauma. 1999;46(3):369–71; discussion 372–3. http://www.ncbi.nlm.nih.gov/pubmed/10088835. Accessed 2 Feb 2015.
Sepehripour AH, Farid S, Shah R. Is routine chest radiography indicated following chest drain removal after cardiothoracic surgery? Interact Cardiovasc Thorac Surg. 2012;14(6):834–8. doi:10.1093/icvts/ivs037.
Karmakar MK, Ho AM-H. Acute pain management of patients with multiple fractured ribs. J Trauma. 2003;54(3):615–25. doi:10.1097/01.TA.0000053197.40145.62.
Simon B, Ebert J, Bokhari F, et al. Management of pulmonary contusion and flail chest: an Eastern association for the surgery of trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S351–61. doi:10.1097/TA.0b013e31827019fd.
Carrier FM, Turgeon AF, Nicole PC, et al. Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2009;56(3):230–42. doi:10.1007/s12630-009-9052-7.
Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy–a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2006;96(4):418–26. doi:10.1093/bja/ael020.
Wardhan R. Assessment and management of rib fracture pain in geriatric population: an ode to old age. Curr Opin Anaesthesiol. 2013. doi:10.1097/01.aco.0000432516.93715.a7.
Conlon NP, Shaw AD, Grichnik KP. Postthoracotomy paravertebral analgesia: will it replace epidural analgesia? Anesthesiol Clin. 2008;26(2):369–80. doi:10.1016/j.anclin.2008.01.003.
Daly DJ, Myles PS. Update on the role of paravertebral blocks for thoracic surgery: are they worth it? Curr Opin Anaesthesiol. 2009;22(1):38–43. doi:10.1097/ACO.0b013e32831a4074.
Guimarães M, El Dib R. Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. … Database Syst Rev. 2009;(2). doi:10.1002/14651858.CD006058.pub2/pdf/standard. http://onlinelibrary.wiley.com. Accessed 28 Jan 2015.
Freitas ER, Soares BG, Cardoso JR, Atallah ÁN. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft. Cochrane Database Syst Rev. 2012 Sep 12;9:CD004466. doi:10.1002/14651858.CD004466.pub3.
Agostini P, Naidu B, Cieslik H, et al. Effectiveness of incentive spirometry in patients following thoracotomy and lung resection including those at high risk for developing pulmonary complications. Thorax. 2013;68(6):580–5. doi:10.1136/thoraxjnl-2012-202785.
Dehghan N, de Mestral C, McKee MD, Schemitsch EH, Nathens A. Flail chest injuries: a review of outcomes and treatment practices from the national trauma data bank. J Trauma Acute Care Surg. 2014;76(2):462–8. doi:10.1097/TA.0000000000000086.
Thoracic American Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416. doi:10.1164/rccm.200405-644ST.
Keenan SP, Sinuff T, Burns KEA, et al. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2011;183(3):E195–214. doi:10.1503/cmaj.100071.
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Haas, B., Nathens, A.B. (2015). Postoperative Care Including Chest Tube Management. In: McKee, M., Schemitsch, E. (eds) Injuries to the Chest Wall. Springer, Cham. https://doi.org/10.1007/978-3-319-18624-5_13
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DOI: https://doi.org/10.1007/978-3-319-18624-5_13
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