Complications associated with pre-hospital open thoracostomies: a rapid review

Abstract Background Open thoracostomies have become the standard of care in pre-hospital critical care in patients with chest injuries receiving positive pressure ventilation. The procedure has embedded itself as a rapid method to decompress air or fluid in the chest cavity since its original descri...

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Main Authors:	Stian Mohrsen, Niall McMahon, Alasdair Corfield, Sinéad McKee
Format:	article
Language:	EN
Published:	BMC 2021
Subjects:	Emergency medical services Critical care Thoracic injuries Pneumothorax Thoracostomy Intraoperative complications Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Online Access:	https://doaj.org/article/11561a6f21e44e72bcf3fe3016e0be28
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spelling	oai:doaj.org-article:11561a6f21e44e72bcf3fe3016e0be282021-12-05T12:10:52ZComplications associated with pre-hospital open thoracostomies: a rapid review10.1186/s13049-021-00976-11757-7241https://doaj.org/article/11561a6f21e44e72bcf3fe3016e0be282021-12-01T00:00:00Zhttps://doi.org/10.1186/s13049-021-00976-1https://doaj.org/toc/1757-7241Abstract Background Open thoracostomies have become the standard of care in pre-hospital critical care in patients with chest injuries receiving positive pressure ventilation. The procedure has embedded itself as a rapid method to decompress air or fluid in the chest cavity since its original description in 1995, with a complication rate equal to or better than the out-of-hospital insertion of indwelling pleural catheters. A literature review was performed to explore potential negative implications of open thoracostomies and discuss its role in mechanically ventilated patients without clinical features of pneumothorax. Main findings A rapid review of key healthcare databases showed a significant rate of complications associated with pre-hospital open thoracostomies. Of 352 thoracostomies included in the final analysis, 10.6% (n = 38) led to complications of which most were related to operator error or infection (n = 26). Pneumothoraces were missed in 2.2% (n = 8) of all cases. Conclusion There is an appreciable complication rate associated with pre-hospital open thoracostomy. Based on a risk/benefit decision for individual patients, it may be appropriate to withhold intervention in the absence of clinical features, but consideration must be given to the environment where the patient will be monitored during care and transfer. Chest ultrasound can be an effective assessment adjunct to rule in pneumothorax, and may have a role in mitigating the rate of missed cases.Stian MohrsenNiall McMahonAlasdair CorfieldSinéad McKeeBMCarticleEmergency medical servicesCritical careThoracic injuriesPneumothoraxThoracostomyIntraoperative complicationsMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENScandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 29, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Emergency medical services Critical care Thoracic injuries Pneumothorax Thoracostomy Intraoperative complications Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Emergency medical services Critical care Thoracic injuries Pneumothorax Thoracostomy Intraoperative complications Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Stian Mohrsen Niall McMahon Alasdair Corfield Sinéad McKee Complications associated with pre-hospital open thoracostomies: a rapid review
description	Abstract Background Open thoracostomies have become the standard of care in pre-hospital critical care in patients with chest injuries receiving positive pressure ventilation. The procedure has embedded itself as a rapid method to decompress air or fluid in the chest cavity since its original description in 1995, with a complication rate equal to or better than the out-of-hospital insertion of indwelling pleural catheters. A literature review was performed to explore potential negative implications of open thoracostomies and discuss its role in mechanically ventilated patients without clinical features of pneumothorax. Main findings A rapid review of key healthcare databases showed a significant rate of complications associated with pre-hospital open thoracostomies. Of 352 thoracostomies included in the final analysis, 10.6% (n = 38) led to complications of which most were related to operator error or infection (n = 26). Pneumothoraces were missed in 2.2% (n = 8) of all cases. Conclusion There is an appreciable complication rate associated with pre-hospital open thoracostomy. Based on a risk/benefit decision for individual patients, it may be appropriate to withhold intervention in the absence of clinical features, but consideration must be given to the environment where the patient will be monitored during care and transfer. Chest ultrasound can be an effective assessment adjunct to rule in pneumothorax, and may have a role in mitigating the rate of missed cases.
format	article
author	Stian Mohrsen Niall McMahon Alasdair Corfield Sinéad McKee
author_facet	Stian Mohrsen Niall McMahon Alasdair Corfield Sinéad McKee
author_sort	Stian Mohrsen
title	Complications associated with pre-hospital open thoracostomies: a rapid review
title_short	Complications associated with pre-hospital open thoracostomies: a rapid review
title_full	Complications associated with pre-hospital open thoracostomies: a rapid review
title_fullStr	Complications associated with pre-hospital open thoracostomies: a rapid review
title_full_unstemmed	Complications associated with pre-hospital open thoracostomies: a rapid review
title_sort	complications associated with pre-hospital open thoracostomies: a rapid review
publisher	BMC
publishDate	2021
url	https://doaj.org/article/11561a6f21e44e72bcf3fe3016e0be28
work_keys_str_mv	AT stianmohrsen complicationsassociatedwithprehospitalopenthoracostomiesarapidreview AT niallmcmahon complicationsassociatedwithprehospitalopenthoracostomiesarapidreview AT alasdaircorfield complicationsassociatedwithprehospitalopenthoracostomiesarapidreview AT sineadmckee complicationsassociatedwithprehospitalopenthoracostomiesarapidreview
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Complications associated with pre-hospital open thoracostomies: a rapid review

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