Chest trauma: First 48 hours management - 31/03/17
Expert's group
Marc Freysz j, Dominique Savary j, Fatima Rayeh-Pelardy j, Christian Laplace j, Raphaelle Duponq j, Valérie Monnin Bares j, Xavier Benoît D’Journo j, Guillaume Boddaert j, Mathieu Boutonnet j, Sébastien Pierre j, Marc Léone j, Didier Honnart j, Mathieu Biais j, Fanny Vardon jpages | 11 |
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Abstract |
Chest trauma remains an issue for health services for both severe and apparently mild trauma management. Severe chest trauma is associated with high mortality and is considered liable for 25% of mortality in multiple traumas. Moreover, mild trauma is also associated with significant morbidity especially in patients with preexisting conditions. Thus, whatever the severity, a fast-acting strategy must be organized. At this time, there are no guidelines available from scientific societies. These expert recommendations aim to establish guidelines for chest trauma management in both prehospital an in hospital settings, for the first 48hours. The “Société française d’anesthésie réanimation” and the “Société française de médecine d’urgence” worked together on the 7 following questions: (1) criteria defining severity and for appropriate hospital referral; (2) diagnosis strategy in both pre- and in-hospital settings; (3) indications and guidelines for ventilatory support; (4) management of analgesia; (5) indications and guidelines for chest tube placement; (6) surgical and endovascular repair indications in blunt chest trauma; (7) definition, medical and surgical specificity of penetrating chest trauma. For each question, prespecified “crucial” (and sometimes also “important”) outcomes were identified by the panel of experts because it mattered for patients. We rated evidence across studies for these specific clinical outcomes. After a systematic Grade® approach, we defined 60 recommendations. Each recommendation has been evaluated by all the experts according to the DELPHI method.
Le texte complet de cet article est disponible en PDF.Keywords : Chest Trauma, Intensive Care, Severity Criteria, Ventilation, Analgesia, Blunt Chest Trauma, Penetrating Chest Trauma
Plan
Vol 36 - N° 2
P. 135-145 - avril 2017 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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