Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 6 , ISSUE 3 ( September-December, 2017 ) > List of Articles

ORIGINAL ARTICLE

Ventana Pericardica: Abordaje Subxifoideo vs Toracoscopico En Trauma Precordial Abierto

Laura J Delgado Mateus, Ada M Bustos Guerrero, Andrés G Barco Manrique, Juan P Serrano Pastrana, Oscar F Herrán Falla, Laura I Valencia-Ángel

Citation Information : Mateus LJ, Guerrero AM, Manrique AG, Pastrana JP, Falla OF, Valencia-Ángel LI. Ventana Pericardica: Abordaje Subxifoideo vs Toracoscopico En Trauma Precordial Abierto. Panam J Trauma Crit Care Emerg Surg 2017; 6 (3):135-141.

DOI: 10.5005/jp-journals-10030-1183

License: CC BY 3.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introducción

La ventana pericárdica es el estándar de oro en el diagnóstico de trauma cardiaco en heridas precordiales estando descritas diferentes vías de abordaje. El objetivo de este estudio es comparar las características clínicas, desenlaces y rendimiento diagnóstico de las vías subxifoidea vs. toracoscópica en pacientes con trauma precordial abierto.

Diseño del Estudio

Estudio observacional de cohortes, en un periodo de 56 meses, se recopilaron pacientes con heridas penetrantes en región precordial, hemodinámicamente estables que ingresaron al Servicio de Urgencias, a quienes se indicó la realización de ventana pericárdica para descartar lesiones cardiacas. Se compararon las características clínicas, desenlaces y el rendimiento diagnóstico de las pruebas.

Resultados

Se incluyeron 256 pacientes, 93.4% ingresaron por herida por arma cortopunzante, 18.8% de las ventanas pericárdicas fueron vía toracoscópica, 20.8% resultaron positivas para hemopericardio y 11.5% de las subxifoideas, la mediana de la estancia hospitalaria fue 4 días, 16.0% presentaron complicaciones, 17.8% en pacientes abordados por vía subxifoidea y 8.3% vía toracoscópica siendo más frecuente el hemotórax coagulado, 15.2% fueron llevados a reintervención, la mayoría a toracoscopia para drenaje de hemotórax coagulado (62.5%), la mortalidad fue 1.6%, todos los casos en el grupo del abordaje subxifoideo. La sensibilidad de la ventana pericárdica subxifoidea fue 95.8% y la toracoscópica 90.9%, y la especificidad fue 99.5% y 100%, respectivamente.

Conclusión

El abordaje toracoscópico es una opción diagnóstica con rendimiento similar al subxifoideo. A pesar de establecer una disminución en la mediana de los días como usuarios de sonda de toracostomía, no se observó disminución en los días de estancia hospitalaria.

How to cite this article

Mateus LJD, Guerrero AMB, Manrique AGB, Pastrana JPS, Falla OFH, Valencia-Ángel LI. Ventana Pericardica: Abordaje Subxifoideo vs. Toracoscopico En Trauma Precordial Abierto. Panam J Trauma Crit Care Emerg Surg 2017;6(3):135-141.

Introduction

The pericardial window is the gold standard in the diagnosis of cardiac trauma in precordial wounds and different approaches are described. The aim of this study is to compare the clinical characteristics, outcomes, and diagnostic performance of subxiphoid vs. thoracoscopy in patients with open precordial trauma.

Study design

A 56-month observational study of cohorts collected patients with penetrating wounds in the precordial region was conducted. These patients were hemodynamically stable and admitted to the Emergency Department. They were asked to perform a pericardial window to rule out cardiac lesions. The clinical characteristics, outcomes, and diagnostic performance of the tests were compared.

Results

A total of 256 patients were included in the study. Around 93.4% were injured by a sharp gunshot wound, 18.8% of the pericardial windows were thoracoscopic, 20.8% were positive for hemopericardium, and 11.5% were subxiphoid. The median length of hospital stay was 4 days, we had 16.0% complications, 17.8% in subxiphoid approach, and 8.3% in thoracoscopic patients, with coagulated hemothorax being the most frequent, 15.2% were submitted to reintervention, most of them thoracoscopy for clotted hemothorax drainage (62.5%), mortality was 1.6%, all cases in the subxiphoid group. The sensitivity of the subxiphoid pericardial window was 95.8% and thoracoscopic 90.9%, and the specificity was 99.5% and 100% respectively.

Conclusion

The thoracoscopic approach is a diagnostic option with subxiphoid-like performance. In spite of establishing a decrease in the median of the days as users of thoracostomy tube, no decrease was observed in the days of hospital stay.


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