title: Chest trauma: First 48hours management.
abstract: Chest trauma remains an issue for health services for both severe and apparently mild trauma management. Severe chest trauma is associated with high mortality and is considered liable for 25% of mortality in multiple traumas. Moreover, mild trauma is also associated with significant morbidity especially in patients with preexisting conditions. Thus, whatever the severity, a fast-acting strategy must be organized. At this time, there are no guidelines available from scientific societies. These expert recommendations aim to establish guidelines for chest trauma management in both prehospital an in hospital settings, for the first 48hours. The "Société française d'anesthésie réanimation" and the "Société française de médecine d'urgence" worked together on the 7 following questions: (1) criteria defining severity and for appropriate hospital referral; (2) diagnosis strategy in both pre- and in-hospital settings; (3) indications and guidelines for ventilatory support; (4) management of analgesia; (5) indications and guidelines for chest tube placement; (6) surgical and endovascular repair indications in blunt chest trauma; (7) definition, medical and surgical specificity of penetrating chest trauma. For each question, prespecified "crucial" (and sometimes also "important") outcomes were identified by the panel of experts because it mattered for patients. We rated evidence across studies for these specific clinical outcomes. After a systematic Grade®approach, we defined 60 recommendations. Each recommendation has been evaluated by all the experts according to the DELPHI method.
authors.affiliation: Grenoble Alpes trauma centre, pôle anesthésie-réanimation, CHU de Grenoble, Inserm U1216, institut des neurosciences de Grenoble, université Grenoble Alpes, 38700 La Tronche, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouzat
authors.affiliation: SSPI - accueil des polytraumatisés, hôpital universitaire Pitié-Salpêtrière - Charles-Foix, 75013 Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Raux
authors.affiliation: Service d'anesthésie-réanimation, centre hospitalier Lyon Sud, faculté de médecine Lyon Est, université Lyon 1 Claude-Bernard, 69310 Pierre-Bénite, France.
authors.forename: Jean Stéphane
authors.initials: JS
authors.lastname: David
authors.affiliation: Service des urgences, pôle URMARS, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69003 Lyon, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Tazarourte
authors.affiliation: Pôle urgences adultes - Samu, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Galinski
authors.affiliation: Urgences/Samu CHRU de Besançon, université de Bourgogne Franche Comté, UMR 6249 CNRS/UFC, 25030 Besançon, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Desmettre
authors.affiliation: Pôle de l'urgence, CHU de Lille, 59000 Lille, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Garrigue
authors.affiliation: Service de réanimation polyvalente, pôle anesthésiologie, réanimation, hôpital Sainte-Musse, 83000 Toulon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Ducros
authors.affiliation: Services des urgences adultes, hôpital de la Timone, UMR MD2 - Aix Marseille université, 13005 Marseille, France. Electronic address: pierre.michelet@ap-hm.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Michelet
authors.affiliation: France.
authors.forename: Marc
authors.initials: M
authors.lastname: Freysz
authors.affiliation: France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Savary
authors.affiliation: France.
authors.forename: Fatima
authors.initials: F
authors.lastname: Rayeh-Pelardy
authors.affiliation: France.
authors.forename: Christian
authors.initials: C
authors.lastname: Laplace
authors.affiliation: France.
authors.forename: Raphaelle
authors.initials: R
authors.lastname: Duponq
authors.affiliation: France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Monnin Bares
authors.affiliation: France.
authors.forename: Xavier Benoît
authors.initials: XB
authors.lastname: D'Journo
authors.affiliation: France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Boddaert
authors.affiliation: France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Boutonnet
authors.affiliation: France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Pierre
authors.affiliation: France.
authors.forename: Marc
authors.initials: M
authors.lastname: Léone
authors.affiliation: France.
authors.forename: Didier
authors.initials: D
authors.lastname: Honnart
authors.affiliation: France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Biais
authors.affiliation: France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Vardon
mesh_terms: D019090:Case Management; D003422:Critical Care; D017408:Guidelines as Topic; D006801:Humans; D017410:Practice Guidelines as Topic; D013898:Thoracic Injuries / Q000628:therapy*
keywords: Analgesia; Blunt Chest Trauma; Chest Trauma; Intensive Care; Penetrating Chest Trauma; Severity Criteria; Ventilation