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Thoracic irrigation for traumatic hemothorax: A systematic review and meta-analysis
Nicole B Lyons1, Brianna L Collie, Michael D Cobler-Lichter
1From the Divisions of Trauma, Surgical Critical Care, and Burns, DeWitt Daughtry Family Department of Surgery, Ryder Trauma Center, University of Miami Miller School of Medicine, Miami, Florida.
The Journal of Trauma and Acute Care Surgery
|November 7, 2024
Summary
Thoracic irrigation during tube thoracostomy (TT) for traumatic hemothoraces (HTX) significantly reduces retained HTX requiring reintervention. This meta-analysis suggests irrigation is a beneficial adjunct to initial trauma management.
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Traumatic hemothoraces (HTX) are common injuries managed initially with tube thoracostomy (TT).
- Retained HTX can lead to complications like fibrothorax or empyema, necessitating further interventions.
- The hypothesis is that irrigating the thoracic cavity during TT insertion may prevent retained HTX.
Purpose of the Study:
- To evaluate the efficacy of thoracic irrigation at the time of tube thoracostomy in preventing retained hemothorax.
- To compare the failure rates and secondary intervention requirements between patients undergoing irrigated versus non-irrigated TT.
Main Methods:
- A systematic review and meta-analysis of studies published up to May 2024 was conducted.
- Included studies involved adult trauma patients with traumatic HTX treated with TT, comparing those who received thoracic irrigation.
- Primary outcome was the failure rate (retained HTX requiring secondary intervention); cumulative and meta-analyses were performed.
Main Results:
- Six studies with 1,319 patients (513 irrigated TT, 837 non-irrigated TT) were analyzed.
- The failure rate was significantly lower in the irrigation group (10.7% vs. 18.2%, p < 0.001).
- Irrigated TT was associated with shorter TT duration, hospital, and ICU length of stay (p < 0.05), with no increase in infectious complications or mortality.
Conclusions:
- Simultaneous thoracic irrigation and TT insertion for traumatic HTX is associated with a reduced rate of retained hemothorax.
- Thoracic irrigation should be considered as an adjunct to TT for traumatic HTX.
- Further randomized controlled trials are recommended to establish definitive guidelines.
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