Empiema no hemotórax retido pós-trauma: incidência e fatores associados

Abstract

Introduction: Blunt or penetrating mechanism are frequently cause of thoracic trauma treated by thoracostomy. The retained hemothorax after trauma has been associated with pleural empyema, infectious complication that contributes to morbidity and mortality. There is controversy regarding the treatment of retained hemothorax and its evolution to empyema. Objective: To determine the incidence ofempyema in post-trauma retained hemothorax, associated factors for itsdevelopment and treatment. Method: Study of 61 patients with retained hemothorax in 574 post-trauma thoracostomy between November 2009 and March 2013. The following variables were studied: age, gender, mechanism of injury, affected hemithorax, complications, laparotomy, specific injuries, ribs fractures, trauma scores, time of diagnosis, thoracostomy indication, initially drained volume, permanence of the first drain. Statistical analysis was performed using Persons Chi- Square, Fishers exact or Mann-Whitneys tests. Results: The incidence of empyema in retained hemothorax was 32.8%. Most were male, 20 and 29 years old, victims of injury by firearm. The incidence of empyema was lower in the firearm injuries (p = 0.008) and higher when the drained volume range was between 300 ml and 599 ml (p = 0.03). Twenty patients with retained hemothorax had empyema, ten (50%) weretreated with a single drainage and three (15%) with re-drainage. Forty-one patients had retained hemothorax without empyema, of these, 32 (78%) were treated with a single drainage. Conclusion: The incidence of empyema in retained hemothorax was high. The firearm mechanism of injury was associated with lower incidence of empyema, while a greater association was observed for volume of blood drained above 300 ml. The approach with simple chest drainage followed by observation proved to be feasible and effective.