Pathogenesis of early intrathoracic complications of severe thoracic trauma, ways of their elimination

Background. Severe thoracic trauma is characterized by high mortality (27–35%) among working-age individuals. The main causes of unfavorable outcomes include rapidly progressing intrathoracic complications and the development of infectious processes in 65–70% of deceased patients.

Objective. To evaluate the effectiveness of valve thoracostomy using an original drainage device in the prevention of early intrathoracic complications in patients with severe thoracic trauma compared with standard drainage methods.

Materials and methods. A prospective cohort study was conducted involving 250 patients with severe thoracic trauma admitted to the N.V. Sklifosovsky Research Institute for Emergency Medicine and Pushkin Clinical Hospital from January 2020 to December 2024 (protocol approved by the local ethics committee No. LEC-2019-084). Patients were allocated into two groups: the study group (n=130) with the use of an S-shaped drain with a one-way petal valve, and the control group (n=120) with standard tube drainage. Inclusion criteria: isolated severe thoracic trauma with ISS 16–25 points, age 18–65 years, presence of hemopneumothorax. Exclusion criteria included concomitant traumatic brain injury, ISS greater than 25 points, and multiple organ failure at admission. The primary endpoint was the incidence of infectious complications; secondary endpoints included length of hospital stay, recurrent pneumothorax rate, and gas exchange dynamics (PaO₂/FiO₂). Statistical analysis was performed using the χ² test for categorical variables and the Mann–Whitney U test for continuous variables at a significance level of p<0.05. Results. In the study group, the incidence of infectious complications was 8.5% (11/130) compared with 23.3% (28/120) in the control group (χ²=11.24, p=0.001; OR=0.31, 95% CI 0.15– 0.64). The median length of hospital stay for isolated severe thoracic trauma was 6 days [IQR 5–8] in the study group versus 13 days [IQR 10–16] in the control group (U=2847, p><0.001). Recurrent pneumothorax developed in 1.5% (2/130) of patients in the study group versus 7.5% (9/120) in the control group (χ²=5.89, p=0.015). The oxygenation index on day 3 was 312±45 mmHg in the study group versus 276±52 mmHg in the control group (p=0.002). Mortality was 3.8% (5/130) in the study group versus 5.8% (7/120) in the control group (p=0.48). Conclusions. The use of valve thoracostomy with an S-shaped drain significantly reduces the incidence of infectious complications and recurrent pneumothorax, shortens the length of hospital stay, and improves gas exchange parameters in patients with severe thoracic trauma. Keywords: thoracic injuries [D013898]; pneumothorax [D011030]; shock, hemorrhagic [D012771]; chest tubes [D015505]; thoracostomy [D013906]; rib fractures [D012253]; postoperative complications [D011183]; tomography, X-ray computed [D014057]; pulmonary gas exchange [D011659]; emergency medicine [D004635].> < 0.05.

Results. In the study group, the incidence of infectious complications was 8.5% (11/130) compared with 23.3% (28/120) in the control group (χ²=11.24, p=0.001; OR=0.31, 95% CI 0.15– 0.64). The median length of hospital stay for isolated severe thoracic trauma was 6 days [IQR 5–8] in the study group versus 13 days [IQR 10–16] in the control group (U=2847, p < 0.001). Recurrent pneumothorax developed in 1.5% (2/130) of patients in the study group versus 7.5% (9/120) in the control group (χ²=5.89, p=0.015). The oxygenation index on day 3 was 312±45 mmHg in the study group versus 276±52 mmHg in the control group (p=0.002). Mortality was 3.8% (5/130) in the study group versus 5.8% (7/120) in the control group (p=0.48).

Conclusions. The use of valve thoracostomy with an S-shaped drain significantly reduces the incidence of infectious complications and recurrent pneumothorax, shortens the length of hospital stay, and improves gas exchange parameters in patients with severe thoracic trauma.

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