Cargando…

Occult Pneumothorax in Patients Presenting with Blunt Chest Trauma: An Observational Analysis

Background: We aimed to assess the management and outcome of occult pneumothorax and to determine the factors associated with failure of observational management in patients with blunt chest trauma (BCT). Methods: Patients with BCT were retrospectively identified from the trauma database over 4 year...

Descripción completa

Detalles Bibliográficos
Autores principales: Mahmood, Ismail, Younis, Basil, Ahmed, Khalid, Mustafa, Fuad, El-Menyar, Ayman, Alabdallat, Mohammad, Parchani, Ashok, Peralta, Ruben, Nabir, Syed, Ahmed, Nadeem, Al-Thani, Hassan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: HBKU Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075257/
https://www.ncbi.nlm.nih.gov/pubmed/32206592
http://dx.doi.org/10.5339/qmj.2020.10
_version_ 1783507005746446336
author Mahmood, Ismail
Younis, Basil
Ahmed, Khalid
Mustafa, Fuad
El-Menyar, Ayman
Alabdallat, Mohammad
Parchani, Ashok
Peralta, Ruben
Nabir, Syed
Ahmed, Nadeem
Al-Thani, Hassan
author_facet Mahmood, Ismail
Younis, Basil
Ahmed, Khalid
Mustafa, Fuad
El-Menyar, Ayman
Alabdallat, Mohammad
Parchani, Ashok
Peralta, Ruben
Nabir, Syed
Ahmed, Nadeem
Al-Thani, Hassan
author_sort Mahmood, Ismail
collection PubMed
description Background: We aimed to assess the management and outcome of occult pneumothorax and to determine the factors associated with failure of observational management in patients with blunt chest trauma (BCT). Methods: Patients with BCT were retrospectively identified from the trauma database over 4 years. Data were analyzed and compared on the basis of initial management (conservative vs. tube thoracostomy). Results: Across the study period, 1928 patients were admitted with BCT, of which 150 (7.8%) patients were found to have occult pneumothorax. The mean patient age was 32.8 ± 13.7 years, and the majority were male (86.7%). Positive-pressure ventilation (PPV) was required in 32 patients, and bilateral occult pneumothorax was seen in 25 patients. In 85.3% (n = 128) of cases, occult pneumothorax was managed conservatively, whereas 14.7% (n = 22) underwent tube thoracostomy. Five patients had failed observational treatment requiring delayed tube thoracostomy. Pneumonia was reported in 12.8% of cases. Compared with those who were treated conservatively, patients who underwent tube thoracostomy had thicker pneumothoraxes and a higher rate of lung contusion, rib fracture, pneumonia, prolonged ventilatory days, and prolonged hospital length of stay. Overall mortality was 4.0%. The deceased had more polytrauma and were treated conservatively without a chest tube. Patients who failed conservative management had a higher frequency of lung contusion, greater pneumothorax thickness, higher Injury Severity Scores (ISS), and required more PPV. Conclusions: Occult pneumothorax is not uncommon in BCT and can be successfully managed conservatively with a close clinical follow-up. Intervention should be limited to patients who have an increase in size of the pneumothorax on follow-up or become symptomatic under observation. Patients who fail conservative management may have a greater pneumothorax thickness and higher ISS. However, large prospective studies are warranted to support these findings and to establish the institutional guidelines for the management of occult pneumothorax.
format Online
Article
Text
id pubmed-7075257
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher HBKU Press
record_format MEDLINE/PubMed
spelling pubmed-70752572020-03-23 Occult Pneumothorax in Patients Presenting with Blunt Chest Trauma: An Observational Analysis Mahmood, Ismail Younis, Basil Ahmed, Khalid Mustafa, Fuad El-Menyar, Ayman Alabdallat, Mohammad Parchani, Ashok Peralta, Ruben Nabir, Syed Ahmed, Nadeem Al-Thani, Hassan Qatar Med J Research Article Background: We aimed to assess the management and outcome of occult pneumothorax and to determine the factors associated with failure of observational management in patients with blunt chest trauma (BCT). Methods: Patients with BCT were retrospectively identified from the trauma database over 4 years. Data were analyzed and compared on the basis of initial management (conservative vs. tube thoracostomy). Results: Across the study period, 1928 patients were admitted with BCT, of which 150 (7.8%) patients were found to have occult pneumothorax. The mean patient age was 32.8 ± 13.7 years, and the majority were male (86.7%). Positive-pressure ventilation (PPV) was required in 32 patients, and bilateral occult pneumothorax was seen in 25 patients. In 85.3% (n = 128) of cases, occult pneumothorax was managed conservatively, whereas 14.7% (n = 22) underwent tube thoracostomy. Five patients had failed observational treatment requiring delayed tube thoracostomy. Pneumonia was reported in 12.8% of cases. Compared with those who were treated conservatively, patients who underwent tube thoracostomy had thicker pneumothoraxes and a higher rate of lung contusion, rib fracture, pneumonia, prolonged ventilatory days, and prolonged hospital length of stay. Overall mortality was 4.0%. The deceased had more polytrauma and were treated conservatively without a chest tube. Patients who failed conservative management had a higher frequency of lung contusion, greater pneumothorax thickness, higher Injury Severity Scores (ISS), and required more PPV. Conclusions: Occult pneumothorax is not uncommon in BCT and can be successfully managed conservatively with a close clinical follow-up. Intervention should be limited to patients who have an increase in size of the pneumothorax on follow-up or become symptomatic under observation. Patients who fail conservative management may have a greater pneumothorax thickness and higher ISS. However, large prospective studies are warranted to support these findings and to establish the institutional guidelines for the management of occult pneumothorax. HBKU Press 2020-03-16 /pmc/articles/PMC7075257/ /pubmed/32206592 http://dx.doi.org/10.5339/qmj.2020.10 Text en © 2020 Mahmood, Younis, Ahmed, Mustafa, El-Menyar, Alabdallat, Parchani, Peralta, Nabir, Ahmed, Al- Thani, licensee HBKU Press. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Mahmood, Ismail
Younis, Basil
Ahmed, Khalid
Mustafa, Fuad
El-Menyar, Ayman
Alabdallat, Mohammad
Parchani, Ashok
Peralta, Ruben
Nabir, Syed
Ahmed, Nadeem
Al-Thani, Hassan
Occult Pneumothorax in Patients Presenting with Blunt Chest Trauma: An Observational Analysis
title Occult Pneumothorax in Patients Presenting with Blunt Chest Trauma: An Observational Analysis
title_full Occult Pneumothorax in Patients Presenting with Blunt Chest Trauma: An Observational Analysis
title_fullStr Occult Pneumothorax in Patients Presenting with Blunt Chest Trauma: An Observational Analysis
title_full_unstemmed Occult Pneumothorax in Patients Presenting with Blunt Chest Trauma: An Observational Analysis
title_short Occult Pneumothorax in Patients Presenting with Blunt Chest Trauma: An Observational Analysis
title_sort occult pneumothorax in patients presenting with blunt chest trauma: an observational analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075257/
https://www.ncbi.nlm.nih.gov/pubmed/32206592
http://dx.doi.org/10.5339/qmj.2020.10
work_keys_str_mv AT mahmoodismail occultpneumothoraxinpatientspresentingwithbluntchesttraumaanobservationalanalysis
AT younisbasil occultpneumothoraxinpatientspresentingwithbluntchesttraumaanobservationalanalysis
AT ahmedkhalid occultpneumothoraxinpatientspresentingwithbluntchesttraumaanobservationalanalysis
AT mustafafuad occultpneumothoraxinpatientspresentingwithbluntchesttraumaanobservationalanalysis
AT elmenyarayman occultpneumothoraxinpatientspresentingwithbluntchesttraumaanobservationalanalysis
AT alabdallatmohammad occultpneumothoraxinpatientspresentingwithbluntchesttraumaanobservationalanalysis
AT parchaniashok occultpneumothoraxinpatientspresentingwithbluntchesttraumaanobservationalanalysis
AT peraltaruben occultpneumothoraxinpatientspresentingwithbluntchesttraumaanobservationalanalysis
AT nabirsyed occultpneumothoraxinpatientspresentingwithbluntchesttraumaanobservationalanalysis
AT ahmednadeem occultpneumothoraxinpatientspresentingwithbluntchesttraumaanobservationalanalysis
AT althanihassan occultpneumothoraxinpatientspresentingwithbluntchesttraumaanobservationalanalysis