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. 2023 Mar 20;8(1):e001050.
doi: 10.1136/tsaco-2022-001050. eCollection 2023.

Open versus percutaneous tube thoracostomy with and without thoracic lavage for traumatic hemothorax: a novel randomized controlled simulation trial

Nathaniel R McLauchlan  1 , Noah M Igra  2 , Lydia T Fisher  1 , James P Byrne  3 , Carl A Beyer  1 , Zhi Geng  1 , Daniela Schmulevich  1 , Martha M Brinson  4 , Ryan P Dumas  5 , Daniel N Holena  6 , Allyson M Hynes  7 , Claire B Rosen  1 , Amit N Shah  8 , Michael A Vella  9 , Jeremy W Cannon  4
Affiliations

Open versus percutaneous tube thoracostomy with and without thoracic lavage for traumatic hemothorax: a novel randomized controlled simulation trial

Nathaniel R McLauchlan et al. Trauma Surg Acute Care Open. .

Abstract

Objective: To quantify and assess the relative performance parameters of thoracic lavage and percutaneous thoracostomy (PT) using a novel, basic science 2×2 randomized controlled simulation trial.

Summary background data: Treatment of traumatic hemothorax (HTX) with open tube thoracostomy (TT) is painful and retained HTX is common. PT is potentially less painful whereas thoracic lavage may reduce retained HTX. Yet, procedural time and the feasibility of combining PT with lavage remain undefined.

Methods: A simulated partially clotted HTX (2%-gelatin-saline mixture) was loaded into a TT trainer and then evacuated after randomization to one of four protocols: TT+/-lavage or PT+/-lavage. Standardized inserts with fixed 28-Fr TT or 14-Fr PT positioning were used to minimize tube positioning variability. Lavage consisted of two 500 mL aliquots of warm saline after initial HTX evacuation. The primary outcome was HTX volume evacuated. The secondary outcome was additional procedural time required for the addition of the lavage.

Results: A total of 40 simulated HTX trials were randomized. TT alone evacuated a median of 1236 mL (IQR 1168, 1294) leaving a residual volume of 265 mL (IQR 206, 333). PT alone resulted in a significantly greater median residual volume of 588 mL (IQR 497, 646) (p=0.002). Adding lavage resulted in similar residual volumes for TT compared with TT alone but significantly less for PT compared with PT alone (p=0.002). Lavage increased procedural time for TT by a median of 7.0 min (IQR 6.5, 8.0) vs 11.7 min (IQR 10.2, 12.0) for PT (p<0.001).

Conclusion: This simulation trial characterized HTX evacuation in a standardized fashion. Adding lavage to thoracostomy placement may improve evacuation, particularly for small-diameter tubes, with little added procedural time. Further prospective clinical study is warranted.

Level of evidence: NA.

Keywords: Hemothorax; Thoracic Injuries.

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Conflict of interest statement

Competing interests: ANS is Chief Medical Officer of CLR Medical which makes the CLR irrigator. The remaining authors declare no conflict of interest. This work was made possible through the generous support of the Measey Scholars Program, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania. CLR Medical provided CLR Irrigators in-kind but did not provide study funding and had no role in the study design or data analysis.

Figures

Figure 1
Figure 1
Experimental setup. (A) Schematic of CLR irrigator. (B) CLR irrigator. (C) Limbs & Things Chest Drain & Needle Decompression Trainer with chest pad and 14Fr cook pigtail catheter inserted.
Figure 2
Figure 2
Experimental procedure timeline.
Figure 3
Figure 3
HTX evacuation performance. *P<0.05 compared with all others by Wilcoxon rank sum posthoc test.
Figure 4
Figure 4
Additional procedural time due to performing lavage.
See this image and copyright information in PMC

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