Management of simple and retained hemothorax: A practice management guideline from the Eastern Association for the Surgery of Trauma: Hemothorax Management Guideline

Nimitt J. Patel, Linda Dultz, Husayn A. Ladhani, Daniel C. Cullinane, Eric Klein, Allison G. McNickle, Nikolay Bugaev, Douglas R. Fraser, Susan Kartiko, Chris Dodgion, Peter A. Pappas, Dennis Kim, Sarah Cantrell, John J. Como, George Kasotakis

Research output: Contribution to journalReview articlepeer-review

Abstract

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. Methods: We formulated four questions: 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. Results: 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. Conclusions: For traumatic hemothorax we conditionally recommend pigtail catheters, in hemodynamically stable patients. In patients with rHTX, we conditionally recommend VATS rather than attempting thrombolytic therapy and recommend that it should be performed early (≤4 days).

Original languageEnglish (US)
Pages (from-to)873-884
Number of pages12
JournalAmerican journal of surgery
Volume221
Issue number5
DOIs
StatePublished - May 2021
Externally publishedYes

Keywords

  • Hemothorax
  • Pigtail catheters
  • Thoracoscopy
  • Thrombolytic therapy
  • Tube thoracostomy

ASJC Scopus subject areas

  • Surgery

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