title: Gauze packing as damage control for uncontrollable haemorrhage in severe thoracic trauma.
abstract: BACKGROUND
  The usefulness of thoracic damage control (DC) for trauma requiring a thoracotomy is not established. The aim of this study was to clarify the usefulness of thoracic packing as DC surgery.
  
  
  METHODS
  This was a retrospective case series study of 12 patients with thoracic trauma suffering uncontrollable intrathoracic haemorrhage and shock who underwent intrathoracic packing. Our thoracic DC technique consisted of ligation and packing over the bleeding point or filling gauze in the bleeding spaces as well as packing for the thoracotomy wound. The success rates of intrathoracic haemostasis, changes in the circulation and the volume of discharge from the thoracic tubes were evaluated.
  
  
  RESULTS
  Packing was undertaken for the thoracic wall in five patients, for the lung in four patients, for the vertebrae in two patients and for the descending thoracic aorta in one patient. Haemostasis was achieved successfully in seven cases. Of these, the volume of discharge from the thoracic tube exceeded 400 ml/hr within three hours after packing in three patients, decreased to less than 200 ml/hr within seven hours in six patients and decreased to 100ml/hr within eight hours in six patients. Systolic pressure could be maintained over 70 mmHg by seven hours after packing.
  
  
  CONCLUSIONS
  Intrathoracic packing is useful for some patients, particularly in the space around the vertebrae, at the lung apex, and between the diaphragm and the thoracic wall. After packing, it is advisable to wait for three hours to see whether vital signs can be maintained and then to wait further to see if the discharge from the thoracic tube decreases to less than 200 ml/hr within five hours.
authors: Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. qqc3@urahp.yokohama-cu.ac.jp
authors: Y
authors: Y
authors: Moriwaki
authors: H
authors: H
authors: Toyoda
authors: N
authors: N
authors: Harunari
authors: M
authors: M
authors: Iwashita
authors: T
authors: T
authors: Kosuge
authors: S
authors: S
authors: Arata
authors: N
authors: N
authors: Suzuki
mesh_terms: D000328:Adult; D002675:Child, Preschool; D058450:Endotamponade / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000517:prevention & control*; D015503:Surgical Sponges; D013898:Thoracic Injuries / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult