Chest surgery clinics of North America
-
ARDS is the pulmonary manifestation of both direct and indirect insults to the lung. Trauma patients are at particular risk for ARDS from the direct effects of their injuries, as well as from complications that may occur during their hospital courses. ARDS prevention can be enhanced through diverse areas of medical focus. ⋯ Newer modes of mechanical ventilation may help us to avoid ventilator-induced exacerbation of lung injury. As we define the role of nonconventional therapies, such as anti-inflammatory and anticytokine therapies, our ability to actively interrupt and reverse the progression of the inflammatory cascade will be enhanced. As yet, ARDS continues to be a challenging disease process to both fully understand and successfully treat in our critically ill patients.
-
Evolving technology provides new diagnostic and emergency management options for the surgeon caring for patients with thoracic trauma. Abdominal ultrasound performed by surgeons in the emergency department makes pericardiocentesis and subxyphoid pericardiotomy obsolete. Transesophageal echocardiography supplements aortography in the diagnosis of thoracic aortic injury. ⋯ Pulmonary tractotomy is an innovative approach to through-and-through pulmonary penetrating injuries. Centrifugal pumps add new options to thoracic great-vessel injury management. Endovascular stented grafts will be added to the armentarium of the thoracic surgeon for injured vessels.
-
Thoracic infections following injury are common, with pneumonia and empyema being the most prevalent. Pneumonia may follow all types of injury, and empyema occurs most frequently after chest injuries. Mediastinitis, lung abscess, and pericarditis occur rarely in the trauma patient. An organized approach to diagnosis and treatment is essential in the management of these problems.
-
Injuries to the lung parenchyma occur following both blunt and penetrating trauma and usually are associated with injury to adjacent structures. In most cases, patients with lung injury require little more than chest-tube insertion and supportive care. A thoracotomy is required, however, in approximately 10% of these patients, half of whom will need pulmonary repair or resection. Because serious morbidity and mortality can follow lung injuries, surgeons must have a broad understanding of the causes, types, and pathophysiologies of lung injuries and be able to promptly diagnose and appropriately treat them.
-
Tracheostomy is a common procedure used by a wide variety of surgeons. Complications after tracheostomy have been used as a rationale for prolonging a translaryngeal intubation. Understanding the pathogenesis of tracheostomy complications combined with meticulous surgical and perioperative management avoids the majority of complications. The remaining complications are readily managed and should not provide a rationale for denying intubated patients the benefits of tracheostomy.