Thoracic irrigation prevents retained hemothorax: A prospective propensity scored analysis

Area of Science:

• Trauma Surgery
• Thoracic Surgery
• Critical Care Medicine

Background:

• Hemothorax (HTx) following thoracic trauma often requires thoracostomy tube (TT) placement.
• Up to 20% of patients develop retained hemothorax, necessitating further interventions.
• Prevention strategies for retained hemothorax are less understood than management options.

Purpose of the Study:

• To investigate if thoracic irrigation during initial thoracostomy tube placement reduces the rate of retained hemothorax requiring secondary intervention.
• To evaluate the efficacy of a simple irrigation technique in preventing hemothorax complications.

Main Methods:

• A prospective comparative study involving 296 patients with traumatic hemothorax undergoing thoracostomy tube placement.
• The irrigation group received 1 L of warmed sterile saline during TT insertion, while the control group received standard care.
• Propensity-matched analysis was used to compare secondary intervention rates between groups.

Main Results:

• The secondary intervention rate for retained hemothorax was significantly lower in the thoracic irrigation group (5.6%) compared to the control group (21.8%).
• Thoracic irrigation demonstrated a significant reduction in the need for further procedures (OR, 0.16; p < 0.001).
• No significant differences were observed in TT duration, ventilator days, or length of stay.

Conclusions:

• Thoracic irrigation at the time of initial thoracostomy tube placement is an effective method for preventing retained hemothorax after traumatic hemothorax.
• This intervention significantly decreases the requirement for secondary procedures for definitive management of retained hemothorax.