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Thoracic irrigation prevents retained hemothorax: A prospective propensity scored analysis. J Trauma Acute Care Surg 2017 12;83(6):1136-1141

Date

09/21/2017

Pubmed ID

28930941

DOI

10.1097/TA.0000000000001700

Scopus ID

2-s2.0-85037044566

Abstract

BACKGROUND: Thoracic trauma resulting in hemothorax (HTx) is typically managed with thoracostomy tube (TT) placement; however, up to 20% of patients develop retained HTx which may necessitate further intervention for definitive management. Although optimal management of retained HTx has been extensively researched, little is known about prevention of this complication. We hypothesized that thoracic irrigation at the time of TT placement would significantly decrease the rate of retained HTx necessitating secondary intervention.

METHODS: A prospective, comparative study of patients with traumatic HTx who underwent bedside TT placement was conducted. The control group consisted of patients who underwent standard TT placement, whereas the irrigation group underwent standard TT placement with immediate irrigation using 1 L of warmed sterile 0.9% saline. Patients who underwent emergency thoracotomy, those with TTs removed within 24 hours, or those who died within 30 days of discharge were excluded. The primary end point was secondary intervention defined by additional TT placement or operative management for retained HTx. A propensity-matched analysis was performed with scores estimated using a logistic regression model based on age, sex, mechanism of injury, Abbreviated Injury Scale chest score, and TT size.

RESULTS: In over a 30-month period, a total of 296 patients underwent TT placement for the management of traumatic HTx. Patients were predominantly male (79.6%) at a median age of 40 years and were evenly split between blunt (48.8%) and penetrating (51.2%) mechanisms. Sixty (20%) patients underwent thoracic irrigation at time of initial TT placement. The secondary intervention rate was significantly lower within the study group (5.6% vs. 21.8%; OR, 0.16; p < 0.001). No significant differences in TT duration, ventilator days, or length of stay were noted between the irrigation and control cohort.

CONCLUSION: Thoracic irrigation at the time of initial TT placement for traumatic HTx significantly reduced the need for secondary intervention for retained HTx.

LEVEL OF EVIDENCE: Therapeutic Study, Level III.

Author List

Kugler NW, Carver TW, Milia D, Paul JS

Authors

Thomas W. Carver MD Associate Professor in the Surgery department at Medical College of Wisconsin
David J. Milia MD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Chest Tubes
Female
Follow-Up Studies
Hemothorax
Humans
Male
Middle Aged
Propensity Score
Prospective Studies
Therapeutic Irrigation
Thoracic Injuries
Thoracic Surgery, Video-Assisted
Thoracostomy
Time Factors
Treatment Outcome
jenkins-FCD Prod-387 b0ced2662056320369de4e5cd5f21c218c03feb3