Abstract
BACKGROUND: Tube thoracostomy is usually sufficient treatment for traumatic hemothorax. Occasionally, significant residual collections remain undrained. Open thoracotomy and video-assisted thoracoscopic surgery (VATS) have been used to manage undrained traumatic hemothoraces (UTHs). Both techniques are invasive and harbor risks. More recently, intrapleural administration of thrombolytic agents (streptokinase and urokinase) has been reported as an effective nonoperative treatment of residual collections caused by a variety of diseases. The role of intrapleural thrombolysis (IT) for the treatment of an UTH is inadequately explored. METHODS: Patients with an UTH, defined as more than 300 mL of intrathoracic blood estimated by computed tomographic scan on the third day after chest tube insertion, were followed prospectively for 16 months. IT was instituted according to a standardized protocol using streptokinase or urokinase. IT effectiveness, defined by the incidence of successful resolution of the UTH, and IT safety, defined by the incidence of uncomplicated therapy, was calculated. RESULTS: Of 203 patients with a traumatic hemothorax, managed by tube thoracostomy, 25 (12.3%) developed an UTH. Successful resolution of the UTH was achieved in 23 (92%) patients within 3.4 ± 1.4 days. No bleeding or other significant complications related to IT were recorded. CONCLUSIONS: IT should be the initial treatment of choice for the management of an UTH.
| Original language | English |
|---|---|
| Pages (from-to) | 1175-1178 |
| Number of pages | 4 |
| Journal | Journal of Trauma - Injury, Infection and Critical Care |
| Volume | 62 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2007 |
| Externally published | Yes |
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All Science Journal Classification (ASJC) codes
- Surgery
Cite this
Intrapleural thrombolysis for the management of undrained traumatic hemothorax : A prospective observational study. / Kimbrell, Brian J.; Yamzon, Johnathon; Petrone, Patrizio; Asensio, Juan A.; Velmahos, George C.
In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 62, No. 5, 05.2007, p. 1175-1178.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Intrapleural thrombolysis for the management of undrained traumatic hemothorax
T2 - A prospective observational study
AU - Kimbrell, Brian J.
AU - Yamzon, Johnathon
AU - Petrone, Patrizio
AU - Asensio, Juan A.
AU - Velmahos, George C.
PY - 2007/5
Y1 - 2007/5
N2 - BACKGROUND: Tube thoracostomy is usually sufficient treatment for traumatic hemothorax. Occasionally, significant residual collections remain undrained. Open thoracotomy and video-assisted thoracoscopic surgery (VATS) have been used to manage undrained traumatic hemothoraces (UTHs). Both techniques are invasive and harbor risks. More recently, intrapleural administration of thrombolytic agents (streptokinase and urokinase) has been reported as an effective nonoperative treatment of residual collections caused by a variety of diseases. The role of intrapleural thrombolysis (IT) for the treatment of an UTH is inadequately explored. METHODS: Patients with an UTH, defined as more than 300 mL of intrathoracic blood estimated by computed tomographic scan on the third day after chest tube insertion, were followed prospectively for 16 months. IT was instituted according to a standardized protocol using streptokinase or urokinase. IT effectiveness, defined by the incidence of successful resolution of the UTH, and IT safety, defined by the incidence of uncomplicated therapy, was calculated. RESULTS: Of 203 patients with a traumatic hemothorax, managed by tube thoracostomy, 25 (12.3%) developed an UTH. Successful resolution of the UTH was achieved in 23 (92%) patients within 3.4 ± 1.4 days. No bleeding or other significant complications related to IT were recorded. CONCLUSIONS: IT should be the initial treatment of choice for the management of an UTH.
AB - BACKGROUND: Tube thoracostomy is usually sufficient treatment for traumatic hemothorax. Occasionally, significant residual collections remain undrained. Open thoracotomy and video-assisted thoracoscopic surgery (VATS) have been used to manage undrained traumatic hemothoraces (UTHs). Both techniques are invasive and harbor risks. More recently, intrapleural administration of thrombolytic agents (streptokinase and urokinase) has been reported as an effective nonoperative treatment of residual collections caused by a variety of diseases. The role of intrapleural thrombolysis (IT) for the treatment of an UTH is inadequately explored. METHODS: Patients with an UTH, defined as more than 300 mL of intrathoracic blood estimated by computed tomographic scan on the third day after chest tube insertion, were followed prospectively for 16 months. IT was instituted according to a standardized protocol using streptokinase or urokinase. IT effectiveness, defined by the incidence of successful resolution of the UTH, and IT safety, defined by the incidence of uncomplicated therapy, was calculated. RESULTS: Of 203 patients with a traumatic hemothorax, managed by tube thoracostomy, 25 (12.3%) developed an UTH. Successful resolution of the UTH was achieved in 23 (92%) patients within 3.4 ± 1.4 days. No bleeding or other significant complications related to IT were recorded. CONCLUSIONS: IT should be the initial treatment of choice for the management of an UTH.
UR - http://www.scopus.com/inward/record.url?scp=34248359512&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34248359512&partnerID=8YFLogxK
U2 - 10.1097/TA.0b013e3180500654
DO - 10.1097/TA.0b013e3180500654
M3 - Article
VL - 62
SP - 1175
EP - 1178
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 5
ER -