Suction evacuation of hemothorax

Savage, Stephanie A.; Cibulas, George A.; Ward, Tyler A.; Davis, Corinne A.; Croce, Martin A.; Zarzaur, Ben L.

doi:10.1097/ta.0000000000001099

Cited by 18 publications

(17 citation statements)

References 15 publications

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“…Kugler et al utilized irrigation and suction of the thorax in a pilot study and demonstrated improvements on chest radiograph (40). This was further assessed by Savage et al wherein the authors compared patients receiving suction evacuation compared to historical controls (41). While no demonstrable improvements were made in the rates of empyema or development of retained hemothorax, these efforts highlight the use of minimally invasive techniques that with time may clarify our understanding in preventing empyema and infectious related complications in severely injured patients.…”

Section: Discussionmentioning

confidence: 99%

Complications in tube thoracostomy: Systematic review and meta-analysis

Hernandez

Khatib²,

Prokop³

et al. 2018

J Trauma Acute Care Surg

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Section: Discussionmentioning

confidence: 99%

Complications in tube thoracostomy: Systematic review and meta-analysis

Hernandez

Khatib²,

Prokop³

et al. 2018

J Trauma Acute Care Surg

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“…According to some authors, this intervention may shorten chest tube duration, and decrease the incidence of empyema and recurrent pneumothorax, and the need for additional drainage [35, 36]. However, results of these studies are contradictory and the value of thoracoscopic suction and evacuation still remains debated.…”

Section: Discussionmentioning

confidence: 99%

“…Another topic that was not studied by this review, is immediate thoracoscopic suction and evacuation of hemothoraces and hemopneumothoraces before tube placement. According to some authors, this intervention may shorten chest tube duration, and decrease the incidence of empyema and recurrent pneumothorax, and the need for additional drainage [ 35 , 36 ]. However, results of these studies are contradictory and the value of thoracoscopic suction and evacuation still remains debated.…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of tube thoracostomy following traumatic chest injury; suction versus water seal

Feenstra

Dickhoff

Deunk

2018

Eur J Trauma Emerg Surg

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PurposeTube thoracostomy is frequently used in thoracic trauma patients. However, there is no consensus on whether low pressure suction or water seal is the optimal method of tube management. Against this background, we performed a systematic review of studies comparing suction and water seal management of chest tubes placed for traumatic chest injuries in adults. Evaluated outcomes are duration of chest tube treatment, length of stay in hospital, incidence of persistent air leak, clotted hemothorax, and the need for (re-)interventions.MethodsA systematic literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was performed. Included studies were evaluated according to the Cochrane Collaboration’s tool for assessing the risk of bias, and according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for assessing the quality of evidence.ResultsAfter assessment of 120 identified studies, three RCT’s (randomized controlled trials) were included in this review and meta-analysis. A favorable effect of suction was found for duration of chest tube treatment [MD (mean difference) − 3.38 days, P = 0.005], length of stay in hospital (MD −3.90 days, P = 0.0003), and the incidence of persistent air leak [OR (odds ratio) 0.27, P = 0.001]. No significant difference was found for the incidence of clotted hemothorax and (re-)interventions. The quality of evidence according to GRADE was low, except for persistent air leak (moderate).ConclusionsSuction seems to have a positive effect on duration of chest tube treatment, length of stay in hospital and persistent air leakage in chest trauma. However, available data was limited and the quality of evidence was (very) low to moderate according to GRADE.

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“…A RH occurs when blood is incompletely evacuated or fails to reabsorb from the pleural space and may still develop despite adequate placement of the initial thoracostomy tube (TT). 1,2,[5][6][7] Risk factors for the development of RH include high initial TT blood output, number of TT placed, and duration of TT. 10,11 In addition, higher injury severity score (ISS), presence of bilateral thoracic injuries, and need for mechanical ventilation have also been associated with the risk for developing RH.…”

Section: Etiology/risk Factorsmentioning

confidence: 99%

“…1,4 Confirmation can be obtained with ultrasound, a chest X-ray (CXR), or chest computed tomography (CT). 1,4 Retained hemothorax (RH) is a known sequelae of traumatic HTX but the exact incidence varies in the literature, ranging from 4% to 20% 1,2,[4][5][6][7] and is associated with significant morbidity as well as increased costs and burden to the healthcare system. [8][9][10] There is continuing interest in determining how to best treat RH and this expert narrative review examines the etiology, risk factors, diagnosis, management, and complications associated with RH.…”

Section: Introductionmentioning

confidence: 99%

Management of post-traumatic retained hemothorax

Bozzay

Bradley

2018

Trauma

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Introduction: Chest injuries occur in a significant portion of trauma patients and hemothorax is a common result. While the initial management of traumatic hemothorax is most commonly treated with tube thoracostomy, the management of retained hemothorax is a subject of debate. Recent literature has proposed different methods for treating or preventing retained hemothorax, yet the approach to this pathology is not straightforward. Methods: The literature was reviewed for relevant studies regarding the prevention and management of post-traumatic retained hemothorax. What follows is a review of the recent literature and an algorithm for the approach to treating a traumatic retained hemothorax. Results: Identifying a traumatic retained hemothorax and preventing subsequent complications such as pneumonia, empyema, and fibrothorax are significant issues faced by surgeons. Studies for preventing retained hemothorax have focused on initial chest tube size, location, and peri-procedural placement conditions, as well as thoracic lavage. Several treatment modalities exist, including second drainage procedure and intra-pleural fibrinolytic drug instillation, but videoassisted thoracoscopic surgery is the most common and successful approach. Regardless of the approach to evacuation, early intervention is paramount. Conclusion: Further studies will help characterize appropriate candidates, timing, treatment modalities, and guide therapy for retained hemothorax.

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Suction evacuation of hemothorax

Abstract: Therapeutic/care management study, level IV.

Cited by 18 publications

References 15 publications

Complications in tube thoracostomy: Systematic review and meta-analysis

Complications in tube thoracostomy: Systematic review and meta-analysis

Systematic review and meta-analysis of tube thoracostomy following traumatic chest injury; suction versus water seal

Management of post-traumatic retained hemothorax

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