Bleeding management of thoracic trauma.

IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
Current Opinion in Anesthesiology Pub Date : 2025-04-01 Epub Date: 2025-02-12 DOI:10.1097/ACO.0000000000001469
Marie Werner, Benjamin Bergis, Jacques Duranteau
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引用次数: 0

Abstract

Purpose of review: Thoracic injuries are directly responsible for 20-30% of deaths in severe trauma patients and represent one of the main regions involved in preventable or potentially preventable deaths. Controlling bleeding in thoracic trauma is a major challenge because intrathoracic hemorrhagic lesions can lead to hemodynamic instability and respiratory failure.

Recent findings: The aim of managing intrathoracic hemorrhagic lesions is to control bleeding as quickly as possible and to control any respiratory distress. Extended focus assessment with sonography for trauma enables us to identify intrathoracic bleeding much more quickly and to determine the most appropriate therapeutic strategy.

Summary: Thoracic bleeding can result from the diaphragm, intrathoracic vessels (aorta, but also inferior or superior vena cava, and suprahepatic veins), lung, cardiac, or chest wall injuries. Depending on thoracic lesions (such as hemothorax or hemopericardium), hemodynamic instability, and respiratory failure, a pericardial window approach, sternotomy, thoracotomy, or emergency resuscitation thoracotomy may be considered after discussion with the surgeon. Alongside treatment of injuries, managing oxygenation, ventilation, hemodynamic, and coagulopathy are essential for the patient's outcome.

胸外伤出血的处理。
回顾目的:胸部损伤直接导致20-30%的严重创伤患者死亡,是可预防或潜在可预防死亡的主要区域之一。控制胸外伤出血是一项重大挑战,因为胸内出血性病变可导致血流动力学不稳定和呼吸衰竭。最近发现:处理胸内出血性病变的目的是尽快控制出血和控制任何呼吸窘迫。创伤超声扩展焦点评估使我们能够更快地识别胸内出血,并确定最合适的治疗策略。摘要:胸出血可由膈肌、胸内血管(主动脉、下腔静脉、上腔静脉和肝上静脉)、肺、心脏或胸壁损伤引起。根据胸部病变(如胸血或心包血)、血流动力学不稳定和呼吸衰竭,在与外科医生讨论后可考虑心包窗入路、胸骨切开术、开胸术或紧急开胸术。除了治疗损伤外,管理氧合、通气、血流动力学和凝血功能对患者的预后至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.90
自引率
8.00%
发文量
207
审稿时长
12 months
期刊介绍: ​​​​​​​​Published bimonthly and offering a unique and wide ranging perspective on the key developments in the field, each issue of Current Opinion in Anesthesiology features hand-picked review articles from our team of expert editors. With fifteen disciplines published across the year – including cardiovascular anesthesiology, neuroanesthesia and pain medicine – every issue also contains annotated references detailing the merits of the most important papers.
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