Is Conservative Treatment Effective In Traumatic Occult Pneumothoraxes?
Research Article
DOI:
https://doi.org/10.5281/zenodo.10276918Keywords:
occult pneumothorax, mechanical ventilation, tension pneumothorax, thoracic traumaAbstract
Introduction: Occult pneumothorax (OP) is pneumothorax detected by computed tomography (CT) scans and not detected by direct chest radiography or clinical examinations. It is critical to detect OP early. Because it may progress to tension pneumothorax over time, especially in cases where positive ventilation is required.
Objective: In this study, we aimed to reveal the effectiveness of conservative treatment in cases with OP and the factors associated with the need for tube thoracostomy in cases with thoracic trauma.
Method: In our study, between May 2019 and October 2023, all cases over the age of 18, with blunt and penetrating thorax trauma, isolated thorax trauma, and all cases with multiple trauma accompanied by thorax trauma and who were diagnosed with OP at the first admission were retrospectively examined.
Results: The average age of cases diagnosed with OP was 48.7± 17.8 (min 18, max 93), the number of female cases was 20 (19.6%), and the number of male cases was 82 (82%80.4). The most common trauma mechanism was motor vehicle accident in 42 (41.2%) cases. The average length of stay in cases diagnosed with OP was 6.7±4.4. Conservative treatment was successful in 68 (66.6%) of the OP cases. The most common injuries accompanying OPs were rib fractures in 85 (83.3%) cases.
Conclusion: : Conservative treatment is an effective and safe method. However, we believe that the clinician should carefully select the case on which she/he will apply this treatment. We think that insertion of a chest tube is a method that secures the patient in cases where bilateral OP is detected. MV is an independent risk factor in the progression of OP to tension pneumothorax and there is a strong relationship between MV and chest tube insertion. We think that conservative treatment should not be insisted on if the amount of pneumothorax begins to increase in these cases.
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