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The Role of Regional Block and Sedation Accompanıed Thoracoscopy on the Diagnosis and Treatment of Post-Trauma Patients Chest Tube Inserted

Yıl 2022, Cilt: 44 Sayı: 3, 382 - 389, 14.03.2022
https://doi.org/10.20515/otd.1005679

Öz

Traumatic hemothorax/pneumothorax; is a pathological condition seen in blunt and sharp thoracic traumas and can generally be treated by tube thoracostomy. While patients are being followed up with tube thoracotomy, analgesics support, and respiratory exercise support; emergency thoracotomy is usually not required. Early thoracoscopy is a method that has come to the fore in recent years. This thoracoscopy is known to have therapeutic and diagnostic benefits. In our study; the files of 40 patients who underwent tube thoracostomy after traumatic hemothorax/pneumothorax were reviewed retrospectively. Twenty of these patients, whose radiological and clinical improvement could not be achieved after tube thoracostomy, underwent thoracoscopy with sedo-analgesia on the first day after the procedure. The remaining 20 patients were followed up without any additional procedures. Patients' age, gender, trauma type, tube thoracostomy indication, presence of additional trauma, length of chest tube stay, length of hospital stay, WBC, RDW, %Neu, pO2, pCO2, SO2, presence of tube malposition, and complications were recorded from patient files. Demographic data of the two groups were similar. While tube withdrawal time was 4.7±1.5 days in the thoracoscopy group, it was 6.9±1.9 days in the control group. This difference was statistically significant (p < 0.001). The mean hospital stay was 7.1±2.0 days in the first group, while it was 9.3±3.3 days in the control group. This difference was statistically significant (p=0.014). In both groups, there was a 1 (5%) patient who developed a need for thoracotomy. Thoracoscopy with sedo-analgesia in early period is a safe method for patients who have undergone tube thoracostomy due to trauma. This method reduces the duration of chest tube removal and hospital stay of patients. The need for thoracotomy after follow-up was similar in both groups..

Kaynakça

  • 1- Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma. 1988 Mar;28(3):298-304. doi: 10.1097/00005373-198803000-00004. PMID: 3351988.
  • 2- Cameron P, Dziukas L, Hadj A, et al. Rib fractures in major trauma. Aust N Z J Surg. 1996 Aug;66(8):530-4. doi: 10.1111/j.1445-2197.1996.tb00803.x. PMID: 8712986.
  • 3- Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995 Dec;110(6):1676-80. doi: 10.1016/S0022-5223(95)70030-7. PMID: 8523879.
  • 4- Yalçınkaya İ, Biliciler U. Traumatic bronchial rupture. Eastern Journal of Medicine. 1999;4:39-41
  • 5- Leblebici İ. Kaya Y. Koçak A. Göğüs travmalı 302 olgunun analizi. Türk Gö¤üs Kalp Damar Cerrahisi Dergisi. Ekim 2005, Cilt 13, Sayı 4, Sayfa(lar) 392-396
  • 6- Griffith GL, Todd EP, McMillin RD, et al. Acute traumatic hemothorax. Ann Thorac Surg. 1978 Sep;26(3):204-7. doi: 10.1016/s0003-4975(10)63670-3. PMID: 752290.
  • 7- Meyer DM, Jessen ME, Wait MA, et al. Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial. Ann Thorac Surg. 1997 Nov;64(5):1396-400; discussion 1400-1. doi: 10.1016/S0003-4975(97)00899-0. PMID: 9386710.
  • 8- Knottenbelt JD, Van der Spuy JW. Traumatic haemothorax--experience of a protocol for rapid turnover in 1,845 cases. S Afr J Surg. 1994 Mar;32(1):5-8. PMID: 11218443.
  • 9- Eddy AC, Luna GK, Copass M. Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma. Am J Surg. 1989 May;157(5):494-7. doi: 10.1016/0002-9610(89)90643-0. PMID: 2712206.
  • 10- Divisi D, Battaglia C, De Berardis B, et al Video-assisted thoracoscopy in thoracic injury: early or delayed indication? Acta Biomed. 2004 Dec;75(3):158-63. PMID: 15796089.
  • 11- Ikeya T, Sugiyama S, Koyama S, et al. [Traumatic diaphragmatic hernia repaired by video-assisted thoracic surgery; report of two cases]. Kyobu Geka. 2003 May;56(5):415-8. Japanese. PMID: 12739367.
  • 12- Cobanoğlu U, Sayir F, Mergan D. İzole travmatik hemotoraksın tedavisinde videotorakoskopik cerrahi ilk tercih olmalı mı? Prospektif randomize kontrolü çalışma [Should videothorascopic surgery be the first choice in isolated traumatic hemothorax? A prospective randomized controlled study]. Ulus Travma Acil Cerrahi Derg. 2011 Mar;17(2):117-22. Turkish. doi: 10.5505/tjtes.2011.96777. PMID: 21644088.
  • 13- Hung MH, Hsu HH, Chan KC, et al. Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation. Eur J Cardiothorac Surg. 2014 Oct;46(4):620-5. doi: 10.1093/ejcts/ezu054. Epub 2014 Feb 28. PMID: 24585550.
  • 14- Cangır AK, Nadir A, Akal M, et al. Göğüs Travmalı 532 olgunun analizi. Ulusal travma dergisi, 2000; 6: 100-5
  • 15- American College of Surgeons Committee on Trauma: Thoracic Trauma. In: Advanced Trauma Life Support for Doctors. Instructor Course Manual. Chicago, III: American College of Surgeons; 1997. p. 147-63
  • 16- Abolhoda A, Livingston DH, Donahoo JS, et al. Diagnostic and therapeutic video assisted thoracic surgery (VATS) following chest trauma. Eur J Cardiothorac Surg. 1997 Sep;12(3):356-60. doi: 10.1016/s1010-7940(97)00192-9. PMID: 9332911.
  • 17- Manlulu AV, Lee TW, Thung KH, et al. Current indications and results of VATS in the evaluation and management of hemodynamically stable thoracic injuries. Eur J Cardiothorac Surg. 2004 Jun;25(6):1048-53. doi: 10.1016/j.ejcts.2004.02.017. PMID: 15145008.
  • 18- Ahmed N, Jones D. Video-assisted thoracic surgery: state of the art in trauma care. Injury. 2004 May;35(5):479-89. doi: 10.1016/S0020-1383(03)00289-4. PMID: 15081325.
  • 19- Heniford BT, Carrillo EH, Spain DA, et al. The role of thoracoscopy in the management of retained thoracic collections after trauma. Ann Thorac Surg. 1997 Apr;63(4):940-3. doi: 10.1016/s0003-4975(97)00173-2. PMID: 9124967.
  • 20- Eddy AC, Luna GK, Copass M. Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma. Am J Surg. 1989 May;157(5):494-7. doi: 10.1016/0002-9610(89)90643-0. PMID: 2712206.
  • 21- Parry GW, Morgan WE, Salama FD. Management of haemothorax. Ann R Coll Surg Engl. 1996 Jul;78(4):325-6. PMID: 8712643; PMCID: PMC2502558.
  • 22- Lang-Lazdunski L, Mouroux J, Pons F, et al. Role of videothoracoscopy in chest trauma. Ann Thorac Surg. 1997 Feb;63(2):327-33. doi: 10.1016/s0003-4975(96)00960-5. PMID: 9033295.
  • 23- Hazelrigg SR, Nunchuck SK, Landreneau RJ, et al. Cost analysis for thoracoscopy: thoracoscopic wedge resection. Ann Thorac Surg. 1993 Sep;56(3):633-5. doi: 10.1016/0003-4975(93)90934-a. PMID: 8379757.
  • 24- Landreneau RJ, Hazelrigg SR, Mack MJ, et al. Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 1993 Dec;56(6):1285-9. doi: 10.1016/0003-4975(93)90667-7. PMID: 8267426.
  • 25- Bosanquet D, Farboud A, Luckraz H. A review of diaphragmatic injury. Respiratory Medicine CME 2 2009; 1-6
  • 26- Katlic MR. Video-assisted thoracic surgery utilizing local anesthesia and sedation. Eur J Cardiothorac Surg. 2006 Sep;30(3):529-32. doi: 10.1016/j.ejcts.2006.06.019. Epub 2006 Aug 2. PMID: 16887361.
  • 27- Mineo TC. Epidural anesthesia in awake thoracic surgery. Eur J Cardiothorac Surg. 2007 Jul;32(1):13-9. doi: 10.1016/j.ejcts.2007.04.004. Epub 2007 Apr 27. PMID: 17467287.
  • 28- Chen KC, Cheng YJ, Hung MH, et al. Nonintubated thoracoscopic surgery using regional anesthesia and vagal block and targeted sedation. J Thorac Dis. 2014 Jan;6(1):31-6. doi: 10.3978/j.issn.2072-1439.2014.01.01. PMID: 24455173; PMCID: PMC3895585.

Travma Sonrası Göğüs Tüpü Uygulanan Hastalarda Rejyonel Blok ve Sedasyon Eşliğinde Torakoskopinin Tanı ve Tedavideki Yeri

Yıl 2022, Cilt: 44 Sayı: 3, 382 - 389, 14.03.2022
https://doi.org/10.20515/otd.1005679

Öz

Travmatik hemo/pnömotoraks künt ve keskin toraks travmalarında görülen ve genellikle tüp torakostomi uygulanarak tedavi edilebilen patolojik durumdur. Hastalar tüp torakostomi, analjezik ve solunum egzersizi desteği ile izlenirken acil torakotomi genellikle gerekmez. Erken dönem torakoskopi uygulanması son yıllarda gündeme gelen bir yöntemdir ve bu torakoskopinin tedavi edici ve tanısal faydaları olduğu bilinmektedir. Çalışmamızda travmatik hemo/pnömotoraks sonrası tüp torakostomi uygulanmış 40 hastanın dosyası retrospektif olarak incelenmiştir. Tüp torakostomi uygulanması sonrası radyolojik ve klinik iyileşmesi sağlanamamış bu hasta grubunun 20’sine işlem sonrası birinci günde sedo-analjezi eşliğinde torakoskopi uygulanmış, 20’sine ise ek işlem uygulanmadan takibine devam edilmiştir. Hastaların yaşı, cinsiyeti, travma tipi, tüp torakostomi endikasyonu, ek travmasının varlığı, göğüs tüpü kalış süresi, hastanede yatış süresi, WBC, RDW, %Neu, pO2, pCO2, SO2 değerleri, tüp malpozisyonu varlığı ve gelişen komplikasyonlar hasta dosyalarından kaydedilmiştir. Çalışmaya katılan iki grubun da demografik verileri benzerdi. Tüp çekilme süresi torakoskopi uygulanan grupta ortalama 4,7±1,5 gün iken, kontrol grubunda ise ortalama 6,9±1.9 gündü ve bu fark istatistiksel olarak anlamlıydı (p < 0,001). Torakoskopi uygulanan grubun hastanede yatış süresi ortalama 7,1±2,0 gün iken, kontrol grubunda ise ortalama 9,3±3,3 gündü ve bu fark istatistiksel olarak anlamlıydı (p=0,014). Her iki grupta da 1’er (%5) hastada torakotomi ihtiyacı gelişti. Travma nedeni ile tüp torakostomi uygulanmış hastalara erken dönem sedoanaljezi ile torakoskopi uygulanması güvenli bir yöntemdir ve hastaların göğüs tüpünün çekilme süreleri ile hastanede kalış sürelerini azalttığı görülmektedir. Takip sonrası torakotomi gereksinimi ise iki grupta da benzer bulunmuştur.

Kaynakça

  • 1- Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma. 1988 Mar;28(3):298-304. doi: 10.1097/00005373-198803000-00004. PMID: 3351988.
  • 2- Cameron P, Dziukas L, Hadj A, et al. Rib fractures in major trauma. Aust N Z J Surg. 1996 Aug;66(8):530-4. doi: 10.1111/j.1445-2197.1996.tb00803.x. PMID: 8712986.
  • 3- Ahmed Z, Mohyuddin Z. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995 Dec;110(6):1676-80. doi: 10.1016/S0022-5223(95)70030-7. PMID: 8523879.
  • 4- Yalçınkaya İ, Biliciler U. Traumatic bronchial rupture. Eastern Journal of Medicine. 1999;4:39-41
  • 5- Leblebici İ. Kaya Y. Koçak A. Göğüs travmalı 302 olgunun analizi. Türk Gö¤üs Kalp Damar Cerrahisi Dergisi. Ekim 2005, Cilt 13, Sayı 4, Sayfa(lar) 392-396
  • 6- Griffith GL, Todd EP, McMillin RD, et al. Acute traumatic hemothorax. Ann Thorac Surg. 1978 Sep;26(3):204-7. doi: 10.1016/s0003-4975(10)63670-3. PMID: 752290.
  • 7- Meyer DM, Jessen ME, Wait MA, et al. Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial. Ann Thorac Surg. 1997 Nov;64(5):1396-400; discussion 1400-1. doi: 10.1016/S0003-4975(97)00899-0. PMID: 9386710.
  • 8- Knottenbelt JD, Van der Spuy JW. Traumatic haemothorax--experience of a protocol for rapid turnover in 1,845 cases. S Afr J Surg. 1994 Mar;32(1):5-8. PMID: 11218443.
  • 9- Eddy AC, Luna GK, Copass M. Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma. Am J Surg. 1989 May;157(5):494-7. doi: 10.1016/0002-9610(89)90643-0. PMID: 2712206.
  • 10- Divisi D, Battaglia C, De Berardis B, et al Video-assisted thoracoscopy in thoracic injury: early or delayed indication? Acta Biomed. 2004 Dec;75(3):158-63. PMID: 15796089.
  • 11- Ikeya T, Sugiyama S, Koyama S, et al. [Traumatic diaphragmatic hernia repaired by video-assisted thoracic surgery; report of two cases]. Kyobu Geka. 2003 May;56(5):415-8. Japanese. PMID: 12739367.
  • 12- Cobanoğlu U, Sayir F, Mergan D. İzole travmatik hemotoraksın tedavisinde videotorakoskopik cerrahi ilk tercih olmalı mı? Prospektif randomize kontrolü çalışma [Should videothorascopic surgery be the first choice in isolated traumatic hemothorax? A prospective randomized controlled study]. Ulus Travma Acil Cerrahi Derg. 2011 Mar;17(2):117-22. Turkish. doi: 10.5505/tjtes.2011.96777. PMID: 21644088.
  • 13- Hung MH, Hsu HH, Chan KC, et al. Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation. Eur J Cardiothorac Surg. 2014 Oct;46(4):620-5. doi: 10.1093/ejcts/ezu054. Epub 2014 Feb 28. PMID: 24585550.
  • 14- Cangır AK, Nadir A, Akal M, et al. Göğüs Travmalı 532 olgunun analizi. Ulusal travma dergisi, 2000; 6: 100-5
  • 15- American College of Surgeons Committee on Trauma: Thoracic Trauma. In: Advanced Trauma Life Support for Doctors. Instructor Course Manual. Chicago, III: American College of Surgeons; 1997. p. 147-63
  • 16- Abolhoda A, Livingston DH, Donahoo JS, et al. Diagnostic and therapeutic video assisted thoracic surgery (VATS) following chest trauma. Eur J Cardiothorac Surg. 1997 Sep;12(3):356-60. doi: 10.1016/s1010-7940(97)00192-9. PMID: 9332911.
  • 17- Manlulu AV, Lee TW, Thung KH, et al. Current indications and results of VATS in the evaluation and management of hemodynamically stable thoracic injuries. Eur J Cardiothorac Surg. 2004 Jun;25(6):1048-53. doi: 10.1016/j.ejcts.2004.02.017. PMID: 15145008.
  • 18- Ahmed N, Jones D. Video-assisted thoracic surgery: state of the art in trauma care. Injury. 2004 May;35(5):479-89. doi: 10.1016/S0020-1383(03)00289-4. PMID: 15081325.
  • 19- Heniford BT, Carrillo EH, Spain DA, et al. The role of thoracoscopy in the management of retained thoracic collections after trauma. Ann Thorac Surg. 1997 Apr;63(4):940-3. doi: 10.1016/s0003-4975(97)00173-2. PMID: 9124967.
  • 20- Eddy AC, Luna GK, Copass M. Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma. Am J Surg. 1989 May;157(5):494-7. doi: 10.1016/0002-9610(89)90643-0. PMID: 2712206.
  • 21- Parry GW, Morgan WE, Salama FD. Management of haemothorax. Ann R Coll Surg Engl. 1996 Jul;78(4):325-6. PMID: 8712643; PMCID: PMC2502558.
  • 22- Lang-Lazdunski L, Mouroux J, Pons F, et al. Role of videothoracoscopy in chest trauma. Ann Thorac Surg. 1997 Feb;63(2):327-33. doi: 10.1016/s0003-4975(96)00960-5. PMID: 9033295.
  • 23- Hazelrigg SR, Nunchuck SK, Landreneau RJ, et al. Cost analysis for thoracoscopy: thoracoscopic wedge resection. Ann Thorac Surg. 1993 Sep;56(3):633-5. doi: 10.1016/0003-4975(93)90934-a. PMID: 8379757.
  • 24- Landreneau RJ, Hazelrigg SR, Mack MJ, et al. Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 1993 Dec;56(6):1285-9. doi: 10.1016/0003-4975(93)90667-7. PMID: 8267426.
  • 25- Bosanquet D, Farboud A, Luckraz H. A review of diaphragmatic injury. Respiratory Medicine CME 2 2009; 1-6
  • 26- Katlic MR. Video-assisted thoracic surgery utilizing local anesthesia and sedation. Eur J Cardiothorac Surg. 2006 Sep;30(3):529-32. doi: 10.1016/j.ejcts.2006.06.019. Epub 2006 Aug 2. PMID: 16887361.
  • 27- Mineo TC. Epidural anesthesia in awake thoracic surgery. Eur J Cardiothorac Surg. 2007 Jul;32(1):13-9. doi: 10.1016/j.ejcts.2007.04.004. Epub 2007 Apr 27. PMID: 17467287.
  • 28- Chen KC, Cheng YJ, Hung MH, et al. Nonintubated thoracoscopic surgery using regional anesthesia and vagal block and targeted sedation. J Thorac Dis. 2014 Jan;6(1):31-6. doi: 10.3978/j.issn.2072-1439.2014.01.01. PMID: 24455173; PMCID: PMC3895585.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Mehmet Ali Eryazğan 0000-0002-9513-4380

Onur Karaca 0000-0002-3339-4195

Musa Zengin 0000-0003-2249-6521

Bülent Koçer 0000-0002-7344-9859

Yayımlanma Tarihi 14 Mart 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 44 Sayı: 3

Kaynak Göster

Vancouver Eryazğan MA, Karaca O, Zengin M, Koçer B. The Role of Regional Block and Sedation Accompanıed Thoracoscopy on the Diagnosis and Treatment of Post-Trauma Patients Chest Tube Inserted. Osmangazi Tıp Dergisi. 2022;44(3):382-9.


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