Thoracic irrigation for prevention of secondary intervention after thoracostomy tube drainage for hemothorax: A Western Trauma Association multicenter study.

Autor:	Carver TW; From the Division of Trauma & Critical Care Surgery (T.W.C., K.A.B., J.R.P., R.S.M., N.W.K., M.A.d.M.), Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery (A.E.B.), UC San Diego Health, San Diego, California; Division of Acute Care Surgery (A.G.M.N.), Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada; Division of Trauma (J.M.H.), Ascension via Christi Hospitals, Wichita, Kansas; Division of Trauma (E.M.C.), Denver Health, Denver, Colorado; Division of Trauma (W.L.B.), Scripps Memorial Hospital La Jolla; Division of Trauma (A.N.C., M.J.S.), Scripps Mercy Hospital, San Diego, California; Division of Trauma, Acute Care Surgery, and Surgical Critical Care (K.S.B.), Regions Hospital Health Partners, St. Paul, Minnesota; Division of Trauma and Emergency General Surgery (J.M.B.), Methodist Health System, Dallas, Texas; Division of Trauma (T.R.K.), Mission Health, Ashville, North Carolina; Division of Trauma and Surgical Critical Care (J.J.B., M.J.S.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and Division of Biostatistics (R.D.C., A.S.), Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin., Berndtson AE, McNickle AG, Boyle KA, Haan JM, Campion EM, Biffl WL, Carroll AN, Sise MJ, Berndt KS, Burris JM, Kopelman TR, Blank JJ, Seamon MJ, Peschman JR, Morris RS, Kugler NW, Conrardy RD, Szabo A, de Moya MA
Jazyk:	angličtina
Zdroj:	The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2024 Nov 01; Vol. 97 (5), pp. 724-730. Date of Electronic Publication: 2024 May 20.
DOI:	10.1097/TA.0000000000004364
Abstrakt:	Background: Retained hemothorax (rHTX) requiring intervention occurs in up to 20% of patients who undergo chest tube (TT) placement for a hemothorax (HTX). Thoracic irrigation at the time of TT placement decreases the need for secondary intervention in this patient group but those findings are limited because of the single-center design. A multicenter study was conducted to evaluate the effectiveness of thoracic irrigation. Methods: A multicenter, prospective, observational study was conducted between June 2018 and July 2023. Eleven sites contributed patients. Patients were included if they had a TT placed for a HTX and were excluded if: younger than 18 years, TT for pneumothorax, thoracotomy or video-assisted thoracoscopic surgery performed within 6 hours of TT, TT >24 hours after injury, TT removed <24 hours, or death within 48 hours. Thoracic irrigation was performed at the discretion of the attending. Each hemithorax was considered separately if bilateral HTX. The primary outcome was secondary intervention for HTX-related complications (rHTX, effusion, or empyema). Secondary intervention was defined as: TT placement, instillation of thrombolytics, video-assisted thoracoscopic surgery, or thoracotomy. Irrigated and nonirrigated hemithoraces were compared using a propensity weighted analysis with age, sex, mechanism of injury, Abbreviated Injury Scale chest, and TT size as predictors. Results: Four hundred ninety-three patients with 462 treated hemothoraces were included, 123 (25%) had thoracic irrigation at TT placement. There were no significant demographic differences between the cohorts. Fifty-seven secondary interventions were performed, 10 (8%) and 47 (13%) in the irrigated and non-irrigated groups, respectively ( p = 0.015). Propensity weighted analysis demonstrated a reduction in secondary interventions in the irrigated cohort (odds ratio, 0.56 (0.34-0.85); p = 0.005). Conclusion: This Western Trauma Association multicenter study demonstrates a benefit of thoracic irrigation at the time of TT placement for a HTX. Thoracic irrigation reduces the odds of a secondary intervention for rHTX-related complications by 44%. Level of Evidence: Therapeutic/Care Management; Level II. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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