The current Advanced Trauma Life Support guidelines state that immediate output from a chest drain (also referred to as a tube thoracostomy) of >=1500mL or ongoing blood loss of >=200mL hourly for 2-4 hours are indications for thoracotomy, with the rationale being that the rate of ongoing haemorrhage requires open surgical intervention. This figures aims to be pragmatic and easy to follow, particularly for the stressful trauma environment, but oversimplifies thoracic bleeding for the critically injured patient. It does not consider the mechanism of injury (blunt or penetrating), the patientÂ’s medical co-morbidities including medications, nor the presence of extra-thoracic injury. Furthermore, patients who have significant tissue injury or ongoing bleeding may potentially be coagulopathic and focussed efforts need to be on haemostatic resuscitation before open surgery is entertained. Blunt injured patients can typically have complicated injury patterns, resulting in bleeding from multiple sites, so it is not surprising that outcomes after thoracotomy are poor. This review article aims to summarise the literature regarding thoracotomy after high chest drain output in the setting of blunt trauma. We excluded papers focussing on resuscitative thoracotomies in peri-arrest patients.
Key words: thoracotomy, chest drain, trauma
|
