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Emergency Medicine International
Volume 2015 (2015), Article ID 859130, 6 pages
http://dx.doi.org/10.1155/2015/859130
Clinical Study

Outcome of Concurrent Occult Hemothorax and Pneumothorax in Trauma Patients Who Required Assisted Ventilation

1Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
2Department of Emergency, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
3Clinical Research, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
4Clinical Medicine, Weill Cornell Medical School, P.O. Box 24144, Doha, Qatar
5Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt

Received 26 October 2014; Accepted 3 February 2015

Academic Editor: Seiji Morita

Copyright © 2015 Ismail Mahmood et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. The management and outcomes of occult hemopneumothorax in blunt trauma patients who required mechanical ventilation are not well studied. We aimed to study patients with occult hemopneumothorax on mechanical ventilation who could be carefully managed without tube thoracostomy. Methods. Chest trauma patients with occult hemopneumothorax who were on mechanical ventilation were prospectively evaluated. The presence of hemopneumothorax was confirmed by CT scanning. Hospital length of stay, complications, and outcome were recorded. Results. A total of 56 chest trauma patients with occult hemopneumothorax who were on ventilatory support were included with a mean age of 36 ± 13 years. Hemopneumothorax was managed conservatively in 72% cases and 28% underwent tube thoracostomy as indicated. 29% of patients developed pneumonia, 16% had Acute Respiratory Distress Syndrome (ARDS), and 7% died. Thickness of hemothorax, duration of mechanical ventilation, and development of ARDS were significantly associated with tube thoracostomy in comparison to no-chest tube group. Conclusions. The majority of occult hemopneumothorax can be carefully managed without tube thoracostomy in patients who required positive pressure ventilation. Tube thoracotomy could be restricted to those who had evidence of increase in the size of the hemothorax or pneumothorax on follow-up chest radiographs or developed respiratory compromise.