Patients who required mechanical ventilation or emergency surgery ( thoracotomy or thoracoscopy ) either at the time of admission to the institution or immediately after the tube thoracostomy , patients who had histories of thoracic procedures or chronic pulmonary diseases ( chronic obstructive pulmonary disease , diffuse interstitial lung disease ) , and patients with multiple injuries with severe traumatic brain injury and a Glasgow Coma Scale ( GCS ) score less than 8 of 15 were excluded from the study .