Evaluation Chest tube in patient with rib fracture undergo mechanical ventilation in ICU and operation room in poorsina hospital and aria hospital from sep2014 to aug2016 in Rasht Download PDF

Introduction: Trauma is the most common cause of death in people 1-44 years old, and the third cause of death without consider of age. thoracic traumas are considered as one of the major causes of death of 10 to 30% of the total traumas and it accounts for 25% of deaths caused by trauma. Rib fracture as one of the consequences of thoracic trauma includes about 7 to 40% of the trauma hospitalizations. the treatment of delayed pneumothorax in positive pressure ventilation as one of the rib fracture complications is controversial in scientific texts,and we want to critique it. Material and Method: The current research is a retrospective cohort study that was accomplished in patient with rib fracture referred to Pour Sina and Arya hospital in Rasht during two years, who were candidate for mechanical ventilation (for surgery or hospitalization in the ICU). Researcher-made questionnaire was used as tool to collect data, which it included two parts of demographic information (age, gender, etc.) and the information related to chest trauma (type of trauma, number of broken ribs, damage to other organs at the same time, length of hospitalization, need for ventilation, complications of embedding and removing chest tube thoracostomy). The validity of questionnaire was approved by professors of surgical department. The collected data were analyzed using descriptive statistics and Chi-square test, Mann-Whitney test and by using SPSS 22 software. Results: In this study, 140 patient with rib fracture who were candidate for mechanically ventilation were examined in the two groups with chest tube thoracostomy (n = 65) and without chest tube thoracostomy (n = 75).mean of hospitalization in patients with chest tube thorachostomy was one day longer than that in patients without chest tube thoracostomy. In the group without chest tube thoracostomy, majority of people (78.7%) needed less than 24 hours of mechanical ventilation and in patients with chest tube thoracostomy, majority of patients (41.5%) needed more than 72 hours of mechanical ventilation, In addition, 12.3% of infection was observed in the chest tube thoracostomy, and 20% of the patients experienced symptomatic pneumothorax, after removing chest tube thoracostomy that majority of them (84.6%) were under mechanical ventilation for more than 72 hours before removing chest tube thoracostomy. In the group without chest tube thoracostomy, 77.3% of patients had no complications during and after general anesthesia and mechanical ventilation and 22.7% of patients experienced asymptomatic pneumothorax less than 10% of lung volume (within 48 hours in chest radiography), who were improved under conservative treatment. Conclusion: According to the results of the research, it can be said that the lack of using chest tube thoracostomy in patients with rib fracture, who were candidate for mechanical ventilation is followed by less complications. and we recommended, close observation without chest tube thorachostomy in patients with rib fracture, who were candidate for mechanical ventilation.