Toracoscopia temprana en el manejo del hemotorax traumático

Abstract

Background: the clotted hemothorax is the most common complication in patients receiving conventional management with thoracostomy. Patients with drains between 500 and 1000ml of blood true the chest tube, have a higher incidence of around 20%, increasing length of stay, readmissions and costs. With the increment disponibility of thoracoscopy, its use in the management of chest trauma have increase. Objective: the study aims to compare the result of two types of management: thoracoscopy and thoracostomy in the treatment of such patients. Methods: using a retrospective cohort study were collected medical records of 134 patients with traumatic hemothorax from the surgery department of Kennedy Hospital, between January 2008 and December 2009 who received one of two interventions described. The statistical analysis of the data allowed to determine the outcome of each of the variables in relation to the intervention. Results: early Thoracoscopy involves a greater chance of lung reexpansion (p 0.057), shorter hospital stay (p 0.001), and lower risk of coagulated hemothorax (p0.088) when compared to the thoracostomy. Conclusions: patients with traumatic hemothorax draining blood from 500 to 1000cc, require additional interventions. Early thoracoscopy is suggested in these patients, to decrease coagulated hemothorax, hospital stay and promote lung reexpansion. Further studies are needed in other institutions, to evaluate whether the results are reproducible, and provide more evidence on the issue in order to formalize this practice.