Current Thoracic Surgery 2022 , Vol 7 , Issue 2
Conservative approach versus invasive approach for pneumothorax secondary to blunt trauma
Özgür İşgörücü1
1Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey DOI : 10.26663/cts.2022.011 Viewed : 458 - Downloaded : 217 Background: The management of minimal pneumothorax, which has been detected more frequently with the increasing use of computed tomography, especially after blunt trauma, is controversial. This study aimed to examine the results of patients with pneumothorax secondary to blunt trauma and contribute to the treatment protocol for this group of patients.

Materials and Methods: A retrospective analysis of patients with pneumothorax after blunt trauma (n = 103) presenting to the emergency department during the 1-year period from January 2019 to January 2020 was performed. Oxygen inhalation was performed in patients who were followed up conservatively, and tube thoracostomy was performed in patients who were treated invasively.

Results: Among 766 patients with blunt trauma, 141 (18.4%) patients had a traumatic pneumothorax. Mechanical ventilation was required in 26.2% (n = 27) patients. Further, 73 (70.8%) patients with pneumothorax were followed up conservatively. The remaining 30 (29.1%) patients underwent tube thoracostomy. The median size of the pneumothorax (9 vs. 29 mm; p < 0.0001; hazard ratio [HR] = 5.08) was significantly different between the groups. Multivariate analyses revealed that positive pressure ventilation and pneumothorax size did not pose an additional risk of failure in conservative management (HR = 1.49; p = 0.25 and HR = 10.2; p = 0.09, respectively). Multivariate analyses revealed that the presence of hemothorax and subcutaneous emphysema (HR = 14.4; p = 0.018 and HR = 13.1; p = 0.019, respectively) led to failure of conservative treatment.

Conclusions: The presence of hemothorax and subcutaneous emphysema was an independent factor leading to failure of conservative treatment. In the presence of these two findings indicating major trauma, invasive treatment is recommended. Keywords : trauma, pneumothorax, tube thoracostomy, surgery, mechanical ventilation