Thoracic irrigation in managing traumatic hemothorax: A concise review of techniques and practice variations

Retained hemothorax following tube thoracostomy occurs in up to one-third of thoracic trauma patients, often necessitating additional interventions. Thoracic irrigation has emerged as a potential adjunct to improve pleural drainage. The objective of this concise review is to evaluate the role of thoracic irrigation in the management of traumatic hemothorax by highlighting current standards of care and variations in techniques.

This review searched five search engines, screening studies published before September 26, 2025. Studies focusing on thoracic irrigation in the setting of trauma and hemothorax were included.

A total of six studies were included. Thoracic irrigation in the management of traumatic hemothorax showed significantly lower odds of secondary intervention (OR: 0.16, p < 0.001) and shorter hospital length of stay (7 days vs. 9, p = 0.04) in patients who received thoracic irrigation compared with standard chest tube drainage. Most patients underwent irrigation using medium to large-bore tubes, although one study showed no association between tube size and outcomes. Patients receiving ≥ 1000 milliliters (mL) of irrigation had more hospital-free days compared to those receiving < 1000 mL (p = 0.007), while another study found no significant differences.

Thoracic irrigation shows promise as an adjunct to tube thoracostomy in managing post-traumatic hemothorax, with evidence of reduced retained collections, fewer secondary interventions, and shorter hospital stays. Studies are needed to achieve standardized thoracic irrigation techniques and develop more comprehensive and consistent evidence-based guidelines.