Combined Thoracoscopic Surgery and High-Frequency Ventilation Induce Severe Traumatic Brain Injury and Chest Trauma Recovery

Alla Rosstalnaya ¹*, Djurabay Sabirov ², Ruslan Rakhmanov ³, Anvar Takhirov ⁴

This study demonstrated that combining video-assisted thoracoscopic surgery with high-frequency ventilation improves outcomes in patients with severe traumatic brain injury and chest trauma by enhancing respiratory function and reducing ICU stay and mortality.

Abstract

Background: Traumatic injuries, especially combined injuries involving multiple body regions, have become a significant concern in industrialized nations due to their rising frequency and severity. Among these, chest injuries, particularly closed chest injuries, present critical challenges due to their high mortality rates and frequent occurrence in combined trauma cases. Effective management of such injuries is crucial to improving patient outcomes. Methods: This study analyzed the outcomes of 107 patients with combined severe traumatic brain injury (TBI) and chest trauma treated at the Russian Research Center for Emergency Medicine between 2017 and 2022. Patients were categorized based on respiratory support methods: Group I (52 patients) received artificial pulmonary ventilation (APV) with synchronized intermittent mandatory ventilation volume-controlled (SIMV VC), while Group II (55 patients) was managed with a combination of SIMV VC and high-frequency jet ventilation (sHFJV). Diagnostic and clinical assessments included neurological examinations, radiological imaging, and invasive monitoring. Surgical interventions involved video-assisted thoracoscopy (VATS) for managing chest injuries. Results: Initial assessments revealed severe conditions across both groups. After 12 hours of respiratory support, Group II patients exhibited significant improvements in oxygenation, blood gas parameters, and reduced pulmonary shunt compared to Group I. Group II also experienced shorter durations of respiratory support and ICU stays, and a lower mortality rate (5.45% vs. 17.3% in Group I). Thoracoscopic interventions were successfully performed with reduced postoperative complications and shorter hospital stays in Group II. Conclusion: The combination of SIMV VC and sHFJV significantly improves respiratory outcomes, reduces the duration of mechanical ventilation, and shortens ICU stays compared to SIMV VC alone. Thoracoscopic procedures prove effective for managing select cases of chest trauma. Careful patient evaluation is essential to ensure hemodynamic stability before opting for thoracoscopic interventions. This study underscores the importance of advanced diagnostic tools and minimally invasive techniques in optimizing the management of severe chest trauma and improving overall patient outcomes.

Keywords: Combined injuries, video-assisted thoracoscopic surgery, high-frequency ventilation, respiratory support, traumatic brain injury

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