Urgent thoracotomy for pulmonary or tracheobronchial injury.
Three hundred eighty-eight of 7,283 (5.3%) admitted trauma patients underwent urgent thoracotomy. In 61 patients (15.7%), pulmonary or tracheobronchial injury prompted thoracotomy (11, blunt; 50, penetrating). Pulmonary hemorrhage necessitated thoracotomy in 54 patients (88.5%); tracheobronchial injury in five patients (8.2%). The mortality was 27.9%. Nine patients (14.8%) underwent pneumonectomy: eight died of intractable hemorrhagic shock during thoracotomy despite rapid control of pulmonary hemorrhage: one died of sepsis. Eleven patients (18.0%) underwent lobectomy: six (54.5%) died of concomitant injuries. Thirty-six patients (59.0%) underwent pneumonorrhaphy: one died of concomitant injuries. Five (8.2%) patients underwent tracheobronchial repair: one died of concomitant injuries. Pneumonectomy was uniformly fatal and should be a procedure of last resort in the treatment of pulmonary injury, as lobectomy and pneumonorraphy are better tolerated by these critically ill patients.
Thompson
D A
DA
Division of Trauma, University of Texas Medical School, Houston 77030.
Rowlands
B J
BJ
Walker
W E
WE
Kuykendall
R C
RC
Miller
P W
PW
Fischer
R P
RP
D001980:Bronchi / Q000293:injuries; D004630:Emergencies; D006801:Humans; D055370:Lung Injury; D011013:Pneumonectomy / Q000379:methods; D013898:Thoracic Injuries / Q000401:mortality / Q000601:surgery*; D013908:Thoracotomy; D014132:Trachea / Q000293:injuries; D014949:Wounds, Nonpenetrating / Q000601:surgery*; D014950:Wounds, Penetrating / Q000601:surgery*