Is massive hemothorax still an absolute indication for operation in blunt trauma?

Area of Science:

• Trauma Surgery
• Thoracic Surgery
• Emergency Medicine

Background:

• Massive haemothorax (MHT) is typically treated with surgery, a guideline based on penetrating trauma.
• The necessity of surgical intervention for MHT in blunt trauma patients is not well-established.
• This study investigates the characteristics of blunt trauma patients with MHT who required surgery.

Purpose of the Study:

• To identify characteristics of blunt trauma patients with MHT necessitating surgical intervention.
• To evaluate the efficacy of conservative management versus surgical treatment in MHT patients.
• To determine predictors for surgical intervention in blunt trauma MHT.

Main Methods:

• Retrospective review of patients with traumatic haemothorax or associated thoracic injuries from 2014-2018.
• Inclusion criterion: chest tube drainage meeting MHT criteria.
• Comparison of characteristics between patients undergoing therapeutic surgery and those managed non-therapeutically (including conservative management).

Main Results:

• Forty-four patients were analyzed; 6 received conservative treatment successfully.
• Surgically treated patients exhibited higher pulse rates, lower systolic blood pressure post-resuscitation, and more acidic blood gas levels (lower pH, bicarbonate, base excess).
• Elevated lactate levels were significantly associated with patients requiring surgical bleeding control (p=0.002).

Conclusions:

• Selective conservative management is a viable option for specific MHT patients.
• Lactate levels show potential as a predictive marker for the need for surgical intervention in blunt trauma MHT.
• Further research can refine criteria for surgical intervention in blunt MHT.