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Do vented chest seals differ in efficacy? An experimental evaluation using a swine hemopneumothorax model
Bijan Shams Kheirabadi1, Irasema B Terrazas, Nahir Miranda
1From the US Army Institute of Surgical Research (B.S.K., I.B.T., N.M., A.N.V., H.G.K., F.F.B., M.A.D.), JBSA, Ft Sam Houston, TX; and Neuro Trauma Department (F.A.), Naval Medical Research Center, Silver Spring, MD.
The Journal of Trauma and Acute Care Surgery
|April 20, 2017
Summary
Vented chest seals (CSs) effectively manage bleeding chest wounds and prevent tension pneumothorax (HPTX) in a swine model. Non-vented seals failed, highlighting the need for improved field treatments for HPTX.
Area of Science:
- Trauma care
- Medical device evaluation
- Surgical research
Background:
- Airway compromise is a leading cause of preventable death in combat casualties.
- Tension hemopneumothorax (HPTX) is a critical condition requiring immediate intervention.
- Nonocclusive chest seals (CSs) are used to manage chest wounds.
Purpose of the Study:
- To evaluate the efficacy of five FDA-approved nonocclusive chest seals (CSs).
- To assess the ability of CSs to seal bleeding chest wounds.
- To determine the effectiveness of CSs in preventing tension hemopneumothorax (HPTX).
Main Methods:
- A swine model (n=26) was used to simulate open chest wounds with HPTX.
- Autologous blood was infused to create HPTX, and CSs were applied.
- CS performance was challenged with additional blood infusion and air injection.
- Intrapleural pressure and physiological parameters were monitored.
Main Results:
- CSs with laminar venting channels effectively managed bleeding and prevented HPTX.
- Chest seals with one-way valves showed high failure rates due to leakage or valve clogging.
- Vented seals (Sentinel, Russell) achieved 100% success, while others had lower success rates (HyFin 67%, SAM 25%, Bolin 0%).
Conclusions:
- The sealant and venting functions of chest seals vary significantly.
- Vented chest seals are superior in managing bleeding chest wounds and preventing HPTX.
- Improved chest seal technology is crucial for effective field treatment of HPTX.