Open thoracostomies have become the standard of care in pre-hospital critical care in patients with chest injuries receiving positive pressure ventilation. The procedure has embedded itself as a rapid method to decompress air or fluid in the chest cavity since its original description in 1995, with a complication rate equal to or better than the out-of-hospital insertion of indwelling pleural catheters. A literature review was performed to explore potential negative implications of open thoracostomies and discuss its role in mechanically ventilated patients without clinical features of pneumothorax. A rapid review of key healthcare databases showed a significant rate of complications associated with pre-hospital open thoracostomies. Of 352 thoracostomies included in the final analysis, 10.6% (n = 38) led to complications of which most were related to operator error or infection (n = 26). Pneumothoraces were missed in 2.2% (n = 8) of all cases. There is an appreciable complication rate associated with pre-hospital open thoracostomy. Based on a risk/benefit decision for individual patients, it may be appropriate to withhold intervention in the absence of clinical features, but consideration must be given to the environment where the patient will be monitored during care and transfer. Chest ultrasound can be an effective assessment adjunct to rule in pneumothorax, and may have a role in mitigating the rate of missed cases.

中文翻译：

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与院前开胸手术相关的并发症：快速回顾

开胸手术已成为接受正压通气的胸部损伤患者院前重症监护的护理标准。自 1995 年首次描述以来，该手术已成为一种快速减压胸腔内空气或液体的方法，并发症发生率等于或优于院外置入胸腔导管。进行了文献综述以探讨开胸手术的潜在负面影响，并讨论其在没有气胸临床特征的机械通气患者中的作用。对关键医疗保健数据库的快速审查显示，与院前开胸手术相关的并发症发生率很高。在最终分析中包括的 352 例胸廓切开术中，10 例。6% (n = 38) 导致并发症，其中大部分与操作错误或感染有关 (n = 26)。所有病例中有 2.2% (n = 8) 漏诊气胸。院前开胸手术的并发症发生率很高。根据个体患者的风险/收益决定，在没有临床特征的情况下不进行干预可能是合适的，但必须考虑在护理和转移期间对患者进行监测的环境。胸部超声可以作为判断气胸的有效评估辅助手段，并且可能有助于降低漏诊率。根据个体患者的风险/收益决定，在没有临床特征的情况下不进行干预可能是合适的，但必须考虑在护理和转移期间对患者进行监测的环境。胸部超声可以作为判断气胸的有效评估辅助手段，并且可能有助于降低漏诊率。根据个体患者的风险/收益决定，在没有临床特征的情况下不进行干预可能是合适的，但必须考虑在护理和转移期间对患者进行监测的环境。胸部超声可以作为判断气胸的有效评估辅助手段，并且可能有助于降低漏诊率。