The American Journal of Surgery
Volume 197, Issue 5 , Pages 581-586 , May 2009

The OPTICC trial: a multi-institutional study of occult pneumothoraces in critical care

  • Jean François Ouellet, M.D.

      Affiliations

    • Department of Surgery, Centre Hospitalier Affilie Universitaire De Quebec, Hopital de l'Enfant-Jesus, Quebec City, QC, Canada
    • ,
  • Vincent Trottier, M.D., F.R.C.S.(C.)

      Affiliations

    • Department of Surgery, Centre Hospitalier Affilie Universitaire De Quebec, Hopital de l'Enfant-Jesus, Quebec City, QC, Canada
    • ,
  • Leanne Kmet, M.Sc.

      Affiliations

    • Regional Trauma Services, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta T2N 2T9, Calgary, AB, Canada
    • ,
  • Sandro Rizoli, M.D., F.R.C.S.(C.), F.A.C.S.

      Affiliations

    • Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    • ,
  • Kevin Laupland, M.D., F.R.C.P.C.

      Affiliations

    • Department of Medicine, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta T2N 2T9, Calgary, AB, Canada
    • Department of Critical Care Medicine, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta T2N 2T9, Calgary, AB, Canada
    • ,
  • Chad G. Ball, M.D., F.R.C.S.(C.)

      Affiliations

    • Department of Trauma, Grady Memorial Hospital, Atlanta, GA, USA
    • Department of Surgery, Grady Memorial Hospital, Atlanta, GA, USA
    • Department of Critical Care, Grady Memorial Hospital, Atlanta, GA, USA
    • ,
  • Marco Sirois, M.D., F.R.C.S.(C.)

      Affiliations

    • Sherbroke Medical Centre, Sherbrooke, QC, Canada
    • ,
  • Andrew W. Kirkpatrick, M.D., F.R.C.S.(C.), F.A.C.S.

      Affiliations

    • Regional Trauma Services, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta T2N 2T9, Calgary, AB, Canada
    • Department of Surgery, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta T2N 2T9, Calgary, AB, Canada
    • Department of Critical Care Medicine, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta T2N 2T9, Calgary, AB, Canada
    • Corresponding Author InformationCorresponding author: Tel.: +1-403-944-2888; fax: +1-403-944-8799

Received 8 November 2008 ,Revised 16 December 2008

References 

  1. Salim A, Sangthong B, Martin M, et al. Whole body imaging in blunt multisystem trauma patients without obvious signs of injury: results of a prospective study. Arch Surg. 2006;141:468–473
  2. de Moya MA, Seaver C, Spaniolas K, et al. Occult pneumothorax in trauma patients: development of an objective scoring system. J Trauma. 2007;63:13–17
  3. Plurad D, Green D, Demetriades D, et al. The increasing use of chest computed tomography for trauma: is it being overutilized?. J Trauma. 2007;62:631–635
  4. Stocchetti N, Pagliarini G, Gennari M, et al. Trauma care in Italy: evidence of in-hospital preventable deaths. J Trauma. 1994;36:401–405
  5. Etoch SW, Bar-Natan MF, Miller FB, et al. Tube thoracostomy: factors related to complications. Arch Surg. 1995;130:521–526
  6. Ball CG, Lord J, Laupland KB, et al. Chest tube complications: how well are we training our residents?. Can J Surg. 2007;50:450–458
  7. Ball CG, Hameed SM, Evans D, et al. Occult pneumothorax in the mechanically ventilated trauma patient. Can J Surg. 2003;46:373–379
  8. Ball CG, Kirkpatrick AW, Laupland KB, et al. Incidence, risk factors, and outcomes for occult pneumothoraces in victims of major trauma. J Trauma. 2005;59:917–925
  9. Ball CG, Kirkpatrick AW, Laupland KB, et al. Factors related to the failure of radiographic recognition of occult posttraumatic pneumothoraces. Am J Surg. 2005;189:541–546
  10. Ball CG, Kirkpatrick AW, Fox D, et al. Are occult pneumothoraces truly occult or simply missed?. J Trauma. 2006;60:287–293
  11. Wall SD, Federle MP, Jeffrey RB, et al. CT diagnosis of unsuspected pneumothorax after blunt abdominal trauma. AJR Am J Roentgenol. 1983;141:919–921
  12. Tocino IM, Miller MH, Frederick PR, et al. CT detection of occult pneumothoraces in head trauma. AJR Am J Roentgenol. 1984;143:987–990
  13. Ball CG, Kirkpatrick AW, Feliciano DV. The ocult pneumothorax: what have we learned from the recent literature. Can J Surg in press.
  14. Neff MA, Monk JS, Peters K, et al. Detection of occult pneumothoraces on abdominal computed tomographic scans in trauma patients. J Trauma. 2000;49:281–285
  15. Rhea JT, Novelline RA, Lawrason J, et al. The frequency and significance of thoracic injuries detected on abdominal CT scans of multiple trauma patients. J Trauma. 1989;29:502–505
  16. Garramone RR, Jacob LM, Sahdev P. An objective method to measure and manage occult pneumothoraces. Surg Gynecol Obstet. 1991;173:257–261
  17. Wolfman NT, Myers MS, Glauser SJ, et al. Validity of CT classification on management of occult pneumothorax: a prospective study. AJR Am J Roentgenol. 1998;171:1317–1323
  18. Omert L, Yeaney WW, Protech J. Efficacy of thoracic computerized tomography in blunt chest trauma. Am Surg. 2001;67:660–667
  19. Enderson BL, Abdalla R, Frame SB, et al. Tube thoracostomy for occult pneumothorax: a prospective randomized study of its use. J Trauma. 1993;35:726–730
  20. Brasel KJ, Stafford RE, Weigelt JA, et al. Treatment of occult pneumothoraces from blunt trauma. J Trauma. 1999;46:987–991
  21. Rhea JT, vanSonnenberg E, McLoud TC. Basilar pneumothorax in the supine adult. Radiology. 1979;133:593–595
  22. Gordon R. The deep sulcus sign. Radiology. 1980;136:25–27
  23. Moskowitz PS, Griscom NT. The medial pneumothorax. Radiology. 1976;120:143–147
  24. Ziter FMH, Westcott JL. Supine subpulmonary pneumothorax. AJR Am J Roentgenol. 1981;137:699–701
  25. Lams PM, Jolles H. The effect of lobar collapse on the distribution of free intrapleural air. Radiology. 1982;142:309–312
  26. Hill SL, Edmisten T, Holtzman G, et al. The occult pneumothorax: an increasing entity in trauma. Am Surg. 1999;65:254–258
  27. Guerrero-Lopez F, Vasquez-Mata G, Alcazar-Romero P, et al. Evaluation of the utility of computed tomography in the initial assessment of the critical care patient with chest trauma. Crit Care Med. 2000;28:1370–1375
  28. Collins JC, Levine G, Waxman K. Occult traumatic pneumothorax: immediate tube thoracostomy versus expectant management. Am Surg. 1992;58:743–746
  29. American College of Surgeons, Committee on Trauma. Thoracic trauma. In: Advanced Trauma Life Support Student Course Manual. 2008;p. 85–110Chicago, I::. American College of Surgeons
  30. Kortbeek JB, Al Turki SA, Ali J, et al. Advanced trauma life support, 8th edition, the evidence for change. J Trauma. 2008;64:1638–1650
  31. Kirkpatrick AW, vanWijngaarden St M, Fabian T. Canadian Association of General Surgeons and American College of Surgeons evidence based reviews in surgery (Treatment of occult pneumothoraces from blunt trauma). Can J Surg. 2006;49:358–361
  32. Ball CG, Hameed SM, Evans D, et al. Occult pneumothorax in the mechanically ventilated trauma patient. Can J Surg. 2003;46:373–379
  33. Trupka A, Waydhas C, Hallfeldt KKJ, et al. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma. 1997;43:405–412
  34. Bridges KG, Welch G, Silver M, et al. CT diagnosis of occult pneumothoraces in multiple trauma patients. J Emerg Med. 1993;11:179–186
  35. Karnik AM, Khan FA. Pneumothorax and barotrauma. In:  Parillo JE,  Dellinger RP editor. Critical Care Medicine: Principles of Diagnosis and Management in the Adult. St. Louis: Mosby; 2001;p. 930–948
  36. Kollef MH. Risk factors for the misdiagnosis of pneumothorax in the intensive care unit. Crit Care Med. 1991;19:906–910
  37. Ball CG, Kirkpatrick AW, Laupland KB, et al. Incidence, risk factors, and outcomes for occult pneumothoraces in victims of major trauma. J Trauma. 2005;59:917–924

 Supported by the Derrick Thompson Award of the Canadian Intensive Care Foundation and a grant from the Canadian Trauma Trials Collaborative of the Trauma Association of Canada.

PII: S0002-9610(09)00063-4

doi: 10.1016/j.amjsurg.2008.12.007

The American Journal of Surgery
Volume 197, Issue 5 , Pages 581-586 , May 2009

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