Management of simple and retained hemothorax

Management of simple and retained hemothorax

A practice management guideline from the Eastern Association for the Surgery of Trauma

[Posted 13/May/2021]

AUDIENCE: General Surgery, Cardiology, Internal Medicine

KEY FINDINGS: For traumatic hemothorax, pigtail catheters are conditionally recommend in hemodynamically stable patients. In patients with rHTX, VATS are conditionally recommended rather than attempting thrombolytic therapy and it is recommended that it should be performed early (=4 days).

BACKGROUND: Traumatic hemothorax poses diagnostic and therapeutic challenges both acutely and chronically. A working group of the Eastern Association for the Surgery of Trauma convened to formulate a practice management guideline for traumatic hemothorax.

DETAILS: Four questions were formulated: whether tube thoracostomy vs observation be performed, should pigtail catheter versus thoracostomy tube be placed to drain hemothorax, should thrombolytic therapy be attempted versus immediate thoracoscopic assisted drainage (VATS) in retained hemothorax (rHTX), and should early VATS (=4 days) versus late VATS (>4 days) be performed? A systematic review was undertaken from articles identified in multiple databases. A total of 6391 articles were identified, 14 were selected for guideline construction. Most articles were retrospective with very low-quality evidence. We performed meta-analysis for some of the outcomes for three of the questions.

Copyright © 2021 Elsevier Inc. All rights reserved.

Source: Patel, N. J., Dultz, L., Ladhani, H. A., et al.(2021). Management of simple and retained hemothorax: A practice management guideline from the Eastern Association for the Surgery of Trauma. Am J Surg. 2021; 221(5):873-884. Published: May 1, 2021. DOI: 10.1016/j.amjsurg.2020.11.032