Número de costillas fracturadas como factor relacionado con la mortalidad en pacientes con tórax inestable.

Introduction. Flail chest is rare and unknown factors related to prognosis. Objective. To establish a relationship between the number of broken ribs and mortality in unstable thorax. Material and methods. Flail chest patients admitted from January 2005 to June 2010. We studied demographic and clinic...

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Bibliographic Details
Published in:	Revista de Sanidad Militar Vol. 66; no. 2; pp. 64 - 71
Main Authors:	Jerónimo.-Zalpa, Esteban, García.-Núñez, M. C. Luis Manuel
Format:	Article
Published:	Direccion General de Sanidad Secretaria de la Defensa Nacional mar/abr2012
Subjects:	Rib fractures Mortality Quantitative research Demographic research Systolic blood pressure Heart rate monitoring Abdominal surgery Respiratory distress syndrome
Online Access:	View this record in EBSCOhost

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Summary:	Introduction. Flail chest is rare and unknown factors related to prognosis. Objective. To establish a relationship between the number of broken ribs and mortality in unstable thorax. Material and methods. Flail chest patients admitted from January 2005 to June 2010. We studied demographic and clinical variables. Object of study, relationship between the number of broken ribs and mortality. Statistical analysis and t test and frequency relative of occurrence. Results. 13 patients were admitted. Men-11 (84%), female-2 (16%), age-44 ± 16 years. Predominant mechanism runs over (38.4%). Variables arrival systolic blood pressure 116 ± 31 mmHg, diastolic blood pressure 67 ± 17 mmHg, heart rate 96 ± 24 beats/ min, respiratory rate 24 ± 7 breaths/min, Hb 13.2 g/dL, pH 7.2 ± 0.2; lactate 3 ± 2 mEq/L . Chest tube 10 cases (76.9%). Injury most commonly associated with lung (n = 13, 100%) lesions/patient: 5.4. Most common procedure, laparotomy (30.7%); fixing rib 15.3% (n = 2). Hospital stay-33 ± 29 days, Intensive Care Unit 8 ± 7 days, duration of mechanical ventilation 6 ± 6 days. Unstable anterior chest 7.7%, 92.4% unstable lateral chest, bilateral flail chest 15.3%. Total number of broken ribs: survivors group 6 ± 2, group of non survivors 9 ± 2 (p = 0.07); number of fractured ribs in the unstable segment: survival group 4 ± 1, group of non survivors 9 ± 4 (p = 0.07). Mortality increased progressively from 7-9 broken ribs in total and > 9 fractured ribs on the unstable segment. The total number of fractured ribs was directly related to the number of specific injuries. Morbidity 77%, respiratory distress syndrome in adults most common complication (53.8%) patient/specific 1.4 complications. Mortality 23%, most common cause of death, coagulopathy (66%). Conclusion. In patients with TI, the total number of CF and rib involved in the unstable segment directly related to mortality and the associated number of specific lesions. Introducción. El tórax inestable (TI) es infrecuente y los factores relativos al pronóstico desconocidos. Objetivo. Establecer relación entre el número de costillas fracturadas (CF) y mortalidad en tórax inestable (TI). Material y métodos. Pacientes con TI admitidos de enero 2005-junio 2010. Se estudiaron variables demográficas y clínicas. Objeto de estudio-relación entre número de CF y mortalidad. Análisis estadístico-FRO y prueba t. Resultados. Se admitieron 13 pacientes. Hombres-11 (84%), mujeres-2 (16%); edad-44 ± 16 años. Mecanismo predominante- atropellamiento (38.4%). Variables de arribo-TAS 116 ± 31 mmHg; TAD 67 ± 17 mmHg; FC 96 ± 24 lat/min; FR 24 ± 7 resp/min; Hgb 13.2 g/dL; pH 7.2 ± 0.2; lact 3 ± 2 mEq/L. Tubo pleural-10 casos (76.9%). Lesión asociada más común-pulmón (n = 13; 100%); lesiones/paciente: 5.4. Procedimiento más común-laparotomía (30.7%); fijación costal-15.3% (n = 2). Estancia hospitalaria-33 ± 29 días; Unidad de Terapia Intensiva (UTI) -8 ± 7 días, duración de ventilación mecánica-6 ± 6 días. TI anterior-7.7%, TI lateral-92.4%, TI bilateral-15.3%. No. Total de CF: grupo S-6 ± 2, grupo N/S-9 ± 2 (p = 0.07); No. de CF en el segmento inestable: grupo S-4 ± 1, grupo N/S-9 ± 4 (p = 0.07). La mortalidad se incrementó progre- sivamente a partir de 7-9 CF en total y > 9 CF en segmento inestable. El número total de CF tuvo relación directa con el número de lesiones específicas. Morbilidad-77%; complicación más común-SIRPA (53.8%); complicaciones específicas/paciente-1.4. Mortalidad-23%, causa más común de muerte-coagulopatía (66%). Conclusión. En pacientes con TI, el número total de CF y de costillas involucradas en el segmento inestable se relacionan directamente con la mortalidad y con el número de lesiones específicas asociadas.