Surgical and perioperative management of flail chest with titanium plates: a French cohort series from a thoracic referral center.

J Cardiothorac Surg

Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Médecine Intensive Réanimation, Sorbonne Université, 75020, Paris, France.

Published: January 2023

Background: The development of titanium claw plates has made rib osteosynthesis easy to achieve and led to a renewed interest for this surgery. We report the management of patients referred to the intensive care unit (ICU) of a referral center for surgical rib fracture fixation (SRFF) after chest trauma.

Methods: We performed a retrospective observational cohort study describing the patients' characteristics and analyzing the determinants of postoperative complications.

Results: From November 2013 to December 2016, 42 patients were referred to our center for SRFF: 12 patients (29%) had acute respiratory failure, 6 of whom received invasive mechanical ventilation. The Thoracic Trauma Severity Score (TTSS) was 11.0 [9-12], with 7 [5-9] broken ribs and a flail chest in 92% of cases. A postoperative complication occurred in 18 patients (43%). Five patients developed ARDS (12%). Postoperative pneumonia occurred in 11 patients (26%). Two patients died in the ICU. In multivariable analysis, the Thoracic Trauma Severity Score (TTSS) (OR = 1.89; CI 95% 1.12-3.17; p = 0.016) and the Simplified Acute Physiology Score II without age (OR = 1.17; CI 95% 1.02-1.34; p = 0.024) were independently associated with the occurrence of a postoperative complication.

Conclusion: The TTSS score appears to be accurate for determining thoracic trauma severity. Short and long-term benefit of Surgical Rib Fracture Fixation should be assessed, particularly in non-mechanically ventilated patients.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9850677PMC
http://dx.doi.org/10.1186/s13019-023-02121-8DOI Listing

Publication Analysis

Top Keywords

thoracic trauma
12
trauma severity
12
flail chest
8
referral center
8
patients
8
patients referred
8
surgical rib
8
rib fracture
8
fracture fixation
8
occurred patients
8

Similar Publications

Interpretation of Viscoelastic Hemostatic Assays in Cardiac Surgery Patients: Importance of Clinical Context.

Anesth Analg

January 2025

From the Department of Anesthesiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.

Background: Rotational thromboelastometry (ROTEM) is widely used for point-of-care coagulation testing to reduce blood transfusions. Accurate interpretation of ROTEM data is crucial and requires substantial training. This study investigates the inter- and intrarater reliability of ROTEM interpretation among experts and compares their interpretations with a ROTEM-guided algorithm.

View Article and Find Full Text PDF

Background: Bedside thoracic ultrasound (US) offers numerous advantages over chest X-ray (CXR) for identification of recurrent pneumothoraces (PTX) after tube thoracostomy (TT) removal. Technologic advancements have led to the development of hand-held devices capable of producing high-quality images termed ultra-portable US (UPUS). We hypothesized that UPUS would be as successful as CXR in detecting post-TT removal PTX and would be preferred by patients.

View Article and Find Full Text PDF

Acute pain service was consulted for acute pain management in a 40-year-old male who had sustained multiple bilateral rib fractures following a fall injury. In addition to the rib fractures, the patient had also experienced injuries to his lungs and spinal column, both of which required surgeries. Considering the significant nature of pain due to his rib fractures, a multimodal pain management approach that included both pharmacological and non-pharmacological strategies was utilized.

View Article and Find Full Text PDF

The aim of the present study was to investigate the impact of upper paratracheal lymph node resection on the prognosis of patients with stage IB non-small cell lung cancer (NSCLC). A retrospective analysis of 339 patients with upper lobe stage IB NSCLC who underwent surgery at Sun Yat-Sen University Cancer Center (Guangzhou, China) between 1999 and 2009 was conducted. The Cox regression model was used to investigate prognostic factors.

View Article and Find Full Text PDF

An optimal protective ventilation strategy in lung resection surgery: a prospective, single-center, three-arm randomized controlled trial.

Updates Surg

January 2025

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

Protective ventilation reduces ventilator-induced acute lung injury postoperatively; however, the optimal strategy for one-lung ventilation (OLV) remains unclear. This study compared three protective ventilation strategies with a postoperative partial pressure of oxygen (PaO)/fraction of inspired oxygen (FiO) ratio to reduce the incidence of immediate postoperative pulmonary complications (PPCs) in patients undergoing lung resection surgery. Eighty-seven patients with ASA physical status I-III requiring OLV for lung resection surgery were randomized into three groups according to the applied ventilation strategies: low tidal volume (V) of 4 mL/kg of predicted body weight (PBW) (LV group), medium V of 6 mL/kg of PBW (MV group), and high V of 8 mL/kg of PBW (HV group).

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!