Thoracic irrigation prevents retained hemothorax: a pilot study.
BACKGROUND
Upward of 20% of patients undergoing thoracostomy tube (TT) placement develop retained hemothorax (HTx) requiring secondary intervention. The aim of this study was to define the rate of secondary intervention in patients undergoing prophylactic thoracic irrigation.


METHODS
A prospective observational trial of 20 patients who underwent thoracic irrigation at the time of TT placement was conducted. Patients with HTx identified on chest x-ray were included. After standard placement of a 36-French TT, the HTx was evacuated using a sterile suction catheter advanced within the TT. Warmed sterile saline was instilled into the chest through the TT followed by suction catheter evacuation. The TT was connected to the sterile drainage atrium and suction applied. TTs were managed in accordance with our standard division protocol.


RESULTS
The population was predominantly (70%) male at median age 35 years, median ISS 13, with 55% suffering penetrating trauma. Thirteen (65%) patients underwent TT placement within 6 h of trauma with the remainder within 24 h. Nineteen patients received the full 1000-mL irrigation. The majority demonstrated significant improvement on postprocedure chest x-ray. The secondary intervention rate was 5%. A single patient required VATS on post-trauma day zero for retained HTx. Median TT duration was 5 d with median length of stay of 7 d. No adverse events related to the pleural lavage were noted.


CONCLUSIONS
Thoracic irrigation at the time of TT placement for traumatic HTx may decrease the rate of retained HTx.
['Kugler|Nathan W|NW|', 'Carver|Thomas W|TW|', 'Paul|Jasmeet S|JS|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D015505:Chest Tubes D005260:Female D005500:Follow-Up Studies D006491:Hemothorax D006801:Humans D008297:Male D008875:Middle Aged D010865:Pilot Projects D011183:Postoperative Complications D011446:Prospective Studies D013396:Suction D007507:Therapeutic Irrigation D013907:Thoracostomy D016896:Treatment Outcome D055815:Young Adult
Thoracic irrigation Retained hemothorax Hemothorax Thoracostomy tube Pleural lavage Chest tube