ABSTRACT
Introduction Chest trauma is common, placed within the top three causes of death after injury but the second leading cause of death for those patients dying within one hour of hospital arrival (central nervous system injury being the premier cause). Despite this, approximately three-quarters of chest injuries may be successfully managed non-operatively with simple procedures such as chest drainage, chest physiotherapy and analgesia as appropriate. Those patients requiring surgery may have injuries ranging from minimal (intercostal vessel bleed) to catastrophic (great vessel rupture). For penetrating trauma, the conventional indications for exploration include:
• Any isolated thoracic injury with shock • Initial chest tube output >1500 mL (some use 1000 mL) • A persistent chest tube output >200 to 300 mL per hour over 3-4 hours • Cardiac tamponade • Massive air leak (with impaired oxygenation / ventilation)
The operative mortality following emergent thoracic exploration for trauma is variable but, in general, is reported to be about 30%. One large, multi-institutional study of traumatic lung injury reported a linear increase in operative mortality with the extent of pulmonary resection – tractotomy 13%, wedge resection 30%, lobectomy 43% and pneumonectomy 50% – which is generally consistent across the literature.
