NIVATS (non-intubated video -assisted thoracic surgery) in traumatic retained hemothorax : A case report

NIVATS in traumatic retained hemothorax : A case report

Introduction:The term non-intubated video-assisted thoracic surgery (NIVATS) refers to thoracic operations that are performed without general anesthesia (GA) and mechanical ventilation in spontaneously breathing patient. Nivats have been proved effective in minor, moderate and major thoracic elective surgeries. We describe here a case of post trauma retained hemothorax and its succesful management using NIVATS technique. Case report : A 17 year old male presented to ED with gunshot injury to right side.On presentation his BP-112/70,Pulse-108.The entry wound was in right anterior axillar line,3rd intercostal space and the exit wound being posterior 6th ICS 4 cm lateral to midline.Right sided ICD was placed which drained around 300 ml collection, which progressively decreased over 4-5 days. A chest x-ray showed non expansion of lung with retained hemothorax. A plan for VATS was made and patient was taken to OR . Under epidural, intercostal block with local instillation of 2% lidocaine, VATS was done .All the retained clot was evacuated and post op x-ray showed complete expansion of lung. Patient is doing well and is in regular follow up. Discussion and conclusion: Traditionally such procedure were being performed using General anaesthesia and single lung ventilation. Single lung ventilation may lead to airway injury and barotrauma. Nivats have been used as an effective mode of ventilation in elective thoracic without any harmful effect of single lung ventilation. We describe here the use of NIVATS in traumatic retained hemothorax and its successful management. However more studies are required before it can be liberally applied in trauma.

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