Management of residual hemothorax after trauma

http://www.east.org/resources/treatment-guidelines/hemothorax-and-occult-pneumothorax%2c-management-of

The Eastern Association for the Surgery of Trauma has developed guidelines for management of traumatic hemothorax and pneumothorax. Attempt of initial drainage of hemothorax should be with tube thoracostomy. Complete evacuation of chest following trauma is strongly encouraged as 3% of pts with hemothorax will develop empyema. CT of the chest is indicated in pts with persistent opacity on CXR after tube thoracostomy to determine whether significant undrained fluid exists. Persistent hemothorax after chest tube placement is an independent predictor of development of empyema in 33% of pts. Persistent retained hemothorax after placement of CT should be treated operatively and not with a second chest tube; operative intervention correlates with shorter duration of chest tube drainage, fewer days in hospital and lower hospital costs than placement of second CT. Early VATS is encouraged within first 5 days of hospitalization; there is higher rate of conversion to thoracotomy later in hospital stay due to development of fibrothorax. Intrapleural thrombolytics can be used to improve drainage of subacute collections, day 6-13, in pts who are not good operative candidates; however, it should be used as a second line treatment option.

Thanks to Dr. Monika Krezalek for this topic.