Skip to main content
SpringerLink
Log in

Updates in the Management of Complex Chest Trauma

  • Chapter
  • First Online:
The High-risk Surgical Patient

  • 1404 Accesses

Abstract

Thoracic trauma is the third most common cause of death in trauma patients. Thoracic trauma can lead to injuries such as tension pneumothorax, massive parenchymal bleeding, or fail-chest with respiratory insufficiency. In most cases, conservative treatment with chest tube insertion is sufficient to stabilize the patient. Early identification of parenchymal, airway and/or chest wall lesions is mandatory to avoid life-threatening complications in these high-risk surgical patients. Airway-related injuries in complex chest trauma patients are associated with high mortality rates and the prognosis is poor mostly because of the concomitant injuries. Rib fracture osteosynthesis should be considered in all patients with flail chest and in patients with multiple fractures or in severe (bicortical) displaced fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health. 2000;90:523–6. https://doi.org/10.2105/ajph.90.4.523.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Schieren M, Wappler F, Wafaisade A, et al. Impact of blunt chest trauma on outcome after traumatic brain injury—a matched-pair analysis of the TraumaRegister DGU(R). Scand J Trauma Resusc Emerg Med. 2020;28:21. https://doi.org/10.1186/s13049-020-0708-1.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cohn SM, Dubose JJ. Pulmonary contusion: an update on recent advances in clinical management. World J Surg. 2010;34:1959–70. https://doi.org/10.1007/s00268-010-0599-9.

    Article  PubMed  Google Scholar 

  4. Farzanegan R, Alijanipour P, Akbarshahi H, et al. Major airways trauma, management and long term results. Ann Thorac Cardiovasc Surg. 2011;17:544–51. https://doi.org/10.5761/atcs.oa.11.01679.

    Article  PubMed  Google Scholar 

  5. Pozgain Z, Kristek D, Lovric I, et al. Pulmonary contusions after blunt chest trauma: clinical significance and evaluation of patient management. Eur J Trauma Emerg Surg. 2018;44:773–7. https://doi.org/10.1007/s00068-017-0876-5.

    Article  CAS  PubMed  Google Scholar 

  6. Viano DC, Lau IV. A viscous tolerance criterion for soft tissue injury assessment. J Biomech. 1988;21:387–99. https://doi.org/10.1016/0021-9290(88)90145-5.

    Article  CAS  PubMed  Google Scholar 

  7. Elmali M, Baydin A, Nural MS, et al. Lung parenchymal injury and its frequency in blunt thoracic trauma: the diagnostic value of chest radiography and thoracic CT. Diagn Interv Radiol. 2007;13:179–82.

    PubMed  Google Scholar 

  8. Ganie FA, Lone H, Lone GN, et al. Lung contusion: a clinico-pathological entity with unpredictable clinical course. Bull Emerg Trauma. 2013;1:7–16.

    PubMed  PubMed Central  Google Scholar 

  9. Klein Y, Cohn SM, Proctor KG. Lung contusion: pathophysiology and management. Curr Opin Anaesthesiol. 2002;15:65–8. https://doi.org/10.1097/00001503-200202000-00010.

    Article  PubMed  Google Scholar 

  10. Soar J, Nolan JP, Bottiger BW, et al. European Resuscitation Council Guidelines for Resuscitation 2015: section 3. Adult advanced life support. Resuscitation. 2015;95:100–47. https://doi.org/10.1016/j.resuscitation.2015.07.016.

    Article  PubMed  Google Scholar 

  11. Marasco S, Lee G, Summerhayes R, et al. Quality of life after major trauma with multiple rib fractures. Injury. 2015;46:61–5. https://doi.org/10.1016/j.injury.2014.06.014.

    Article  PubMed  Google Scholar 

  12. Huber S, Biberthaler P, Delhey P, et al. Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry (Trauma Register DGU(R)). Scand J Trauma Resusc Emerg Med. 2014;22:52. https://doi.org/10.1186/s13049-014-0052-4.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hollister M, Stern EJ, Steinberg KP. Type 2 pulmonary laceration: a marker of blunt high-energy injury to the lung. AJR Am J Roentgenol. 1995;165:1126. https://doi.org/10.2214/ajr.165.5.7572488.

    Article  CAS  PubMed  Google Scholar 

  14. ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS Working Group. Advanced trauma life support (ATLS(R)): the ninth edition. J Trauma Acute Care Surg. 2013;74:1363–6. https://doi.org/10.1097/TA.0b013e31828b82f5.

    Article  Google Scholar 

  15. Nishiumi N, Inokuchi S, Oiwa K, et al. Diagnosis and treatment of deep pulmonary laceration with intrathoracic hemorrhage from blunt trauma. Ann Thorac Surg. 2010;89:232–8. https://doi.org/10.1016/j.athoracsur.2009.09.041.

    Article  PubMed  Google Scholar 

  16. Karmy-Jones R, Jurkovich GJ. Blunt chest trauma. Curr Probl Surg. 2004;41:211–380. https://doi.org/10.1016/j.cpsurg.2003.12.004.

    Article  PubMed  Google Scholar 

  17. Schneider T, Volz K, Dienemann H, et al. Incidence and treatment modalities of tracheobronchial injuries in Germany. Interact Cardiovasc Thorac Surg. 2009;8:571–6. https://doi.org/10.1510/icvts.2008.196790.

    Article  PubMed  Google Scholar 

  18. Cheaito A, Tillou A, Lewis C, et al. Traumatic bronchial injury. Int J Surg Case Rep. 2016;27:172–5. https://doi.org/10.1016/j.ijscr.2016.08.014.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Shemmeri E, Vallieres E. Blunt tracheobronchial trauma. Thorac Surg Clin. 2018;28:429–34. https://doi.org/10.1016/j.thorsurg.2018.04.008.

    Article  PubMed  Google Scholar 

  20. Evagelopoulos N, Tossios P, Wanke W, et al. Tracheobronchial rupture after emergency intubation. Thorac Cardiovasc Surg. 1999;47:395–7. https://doi.org/10.1055/s-2007-1013183.

    Article  CAS  PubMed  Google Scholar 

  21. Kiser AC, O’Brien SM, Detterbeck FC. Blunt tracheobronchial injuries: treatment and outcomes. Ann Thorac Surg. 2001;71:2059–65. https://doi.org/10.1016/s0003-4975(00)02453-x.

    Article  CAS  PubMed  Google Scholar 

  22. Mohammadzadeh AR, Kayalha H. Delayed diagnosis of bronchial transection following blunt chest trauma. Asian Cardiovasc Thorac Ann. 2017;25:540–3. https://doi.org/10.1177/0218492317728665.

    Article  PubMed  Google Scholar 

  23. Cardillo G, Carbone L, Carleo F, et al. Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non-surgical treatment. Eur J Cardiothorac Surg. 2010;37:581–7. https://doi.org/10.1016/j.ejcts.2009.07.034.

    Article  PubMed  Google Scholar 

  24. van Roozendaal LM, van Gool MH, Sprooten RTM, et al. Surgical treatment of bronchial rupture in blunt chest trauma: a review of literature. J Thorac Dis. 2018;10:5576–83. https://doi.org/10.21037/jtd.2018.08.22.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tazi-Mezalek R, Musani AI, Laroumagne S, et al. Airway stenting in the management of iatrogenic tracheal injuries: 10-year experience. Respirology. 2016;21:1452–8. https://doi.org/10.1111/resp.12853.

    Article  PubMed  Google Scholar 

  26. Welter S, Krbek T, Halder R, et al. A new technique for complete intraluminal repair of iatrogenic posterior tracheal lacerations. Interact Cardiovasc Thorac Surg. 2011;12:6–9. https://doi.org/10.1510/icvts.2010.248641.

    Article  PubMed  Google Scholar 

  27. Self ML, Mangram A, Berne JD, et al. Nonoperative management of severe tracheobronchial injuries with positive end-expiratory pressure and low tidal volume ventilation. J Trauma. 2005;59:1072–5. https://doi.org/10.1097/01.ta.0000188643.67949.82.

    Article  PubMed  Google Scholar 

  28. Chung J, Berguson M, Mendelson A, et al. Cross-field ventilation for treatment of harlequin syndrome in traumatic tracheobronchial injury repair using intraoperative venoarterial extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth. 2019;33:3090–4. https://doi.org/10.1053/j.jvca.2019.03.033.

    Article  PubMed  Google Scholar 

  29. Moon SH, Kim KN, Jung JJ, et al. Heparin-free veno-venous ECMO applied to a patient with severe lung contusion and hypovolemic shock due to trauma. Ulus Travma Acil Cerrahi Derg. 2018;24:497–500. https://doi.org/10.5505/tjtes.2018.33802.

    Article  PubMed  Google Scholar 

  30. Ludwig C, Koryllos A. Management of chest trauma. J Thorac Dis. 2017;9:S172–7. https://doi.org/10.21037/jtd.2017.03.52.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Pieracci FM, Majercik S, Ali-Osman F, et al. Consensus statement: surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines. Injury. 2017;48:307–21. https://doi.org/10.1016/j.injury.2016.11.026.

    Article  PubMed  Google Scholar 

  32. Liebsch C, Seiffert T, Vlcek M, et al. Patterns of serial rib fractures after blunt chest trauma: an analysis of 380 cases. PLoS One. 2019;14:e0224105. https://doi.org/10.1371/journal.pone.0224105.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Cannon RM, Smith JW, Franklin GA, et al. Flail chest injury: are we making any progress? Am Surg. 2012;78:398–402.

    Article  PubMed  Google Scholar 

  34. Dehghan N, de Mestral C, McKee MD, et al. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg. 2014;76:462–8. https://doi.org/10.1097/TA.0000000000000086.

    Article  PubMed  Google Scholar 

  35. Bemelman M, Baal MV, Raaijmakers C, et al. An interobserver agreement study with a new classification for rib fractures. Chirurgia (Bucur). 2019;114:352–8. https://doi.org/10.21614/chirurgia.114.3.352.

    Article  PubMed  Google Scholar 

  36. Cooper A, Edwards M, Brandling J, et al. Taxonomy of the form and function of primary care services in or alongside emergency departments: concepts paper. Emerg Med J. 2019;36:625–30. https://doi.org/10.1136/emermed-2018-208305.

    Article  PubMed  Google Scholar 

  37. Hennon M, Yendamuri S. Video assisted thoracoscopic surgery vs. thoracotomy for lobectomy: why are we still talking about this? J Thorac Dis. 2019;11:S1284–5. https://doi.org/10.21037/jtd.2019.04.106.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Schulz-Drost S, Grupp S, Pachowsky M, et al. Stabilization of flail chest injuries: minimized approach techniques to treat the core of instability. Eur J Trauma Emerg Surg. 2017;43:169–78. https://doi.org/10.1007/s00068-016-0664-7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, Florence Nightingale Hospital, Düsseldorf, Germany

    Aris Koryllos, Klaus-Marius Bastian & Corinna Ludwig

Authors
  1. Aris Koryllos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klaus-Marius Bastian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Corinna Ludwig
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

  2. Divisione di Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia, Pavia, Italy

    Antonino Massimiliano Grande

  3. Div. of Emerg. Surg., Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

    Ari Leppäniemi

  4. Department of Pathophysiology and Transplantation, General Surgery and Trauma Team, University of Milano, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Osvaldo Chiara

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Koryllos, A., Bastian, KM., Ludwig, C. (2023). Updates in the Management of Complex Chest Trauma. In: Aseni, P., Grande, A.M., Leppäniemi, A., Chiara, O. (eds) The High-risk Surgical Patient. Springer, Cham. https://doi.org/10.1007/978-3-031-17273-1_67

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-17273-1_67

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-17272-4

  • Online ISBN: 978-3-031-17273-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation