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Management of simple and retained hemothorax: A practice management guideline from the Eastern Association for the Surgery of Trauma
Authors: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
Affiliation:1. MetroHealth Medical Center, Case Western Reserve University School of Medicine (CWRU), USA;2. UT Southwestern School of Medicine, USA;3. MetroHealth Medical Center, CWRU, USA;4. Maine Medical Center, USA;5. Northwell Health, USA;6. UNLV School of Medicine, USA;7. Tufts Medical Center, USA;8. George Washington University Hospital, USA;9. Medical College of Wisconsin School of Medicine, USA;10. University of Central Florida College of Medicine, USA;11. Harbor-UCLA Medical Center, USA;12. Duke University Medical Center Library & Archives, Duke University School of Medicine, USA;13. Duke University School of Medicine, USA;1. University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA;1. Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada;2. Department of Thoracic Surgery, Sherbrooke University, Sherbrooke, Quebec, Canada;3. Department of Surgery, London Health Sciences Centre, London, Ontario, Canada;4. Division of Vascular and Endovascular Surgery, University of Ottawa, Ottawa, Ontario, Canada;5. Centre Hospitalier Affile Universitaire De Quebec, Hopital de l’Enfant-Jesus, Quebec City, Quebec, Canada;6. Hamad General Hospital, Doha, Qatar;7. The Trauma Program, Foothills Medical Centre, Calgary, Alberta, Canada;8. Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada;9. Canadian Forces Medical Services, Ottawa, Ontario, Canada;1. Division of Trauma, Department of Emergency, Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan;2. Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;3. Institute of Business and Management, National Chiao Tung University-Taipei, Taipei, Taiwan;4. Shih Chien University-Kaohsiung, Kaohsiung, Taiwan;5. Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;6. Department of Administration Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;7. Department of Emergency Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;8. Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Kweishan, Taoyuan, Taiwan;1. Emergency Department, University Hospital, Federal University of Santa Catarina, 88036-800, Rua Professora Maria Flora Pausewang, Bairro Trindade, Florianópolis, Santa Catarina, Brazil;2. Intensive Care Unit, University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil;3. Department of Clinical Medicine, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil;4. Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil;5. Department of Psychology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil;6. Intensive Care Unit, Nereu Ramos Hospital, Florianópolis, Santa Catarina, Brazil
Abstract:
BackgroundTraumatic 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.MethodsWe 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.ResultsA 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.ConclusionsFor 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).
Keywords:Hemothorax  Thoracoscopy  Pigtail catheters  Tube thoracostomy  Thrombolytic therapy
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