Intrapleural thrombolysis for the management of undrained traumatic hemothorax

A prospective observational study

Brian J. Kimbrell, Johnathon Yamzon, Patrizio Petrone, Juan A. Asensio, George C. Velmahos

Research output: Contribution to journalArticle

32 Citations (Scopus)

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 languageEnglish
Pages (from-to)1175-1178
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume62
Issue number5
DOIs
StatePublished - May 2007
Externally publishedYes

Fingerprint

Hemothorax
Observational Studies
Prospective Studies
Thoracostomy
Streptokinase
Urokinase-Type Plasminogen Activator
Therapeutics
Video-Assisted Thoracic Surgery
Chest Tubes
Fibrinolytic Agents
Incidence
Thoracotomy
Hemorrhage
Safety

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 journalArticle

Kimbrell, Brian J. ; Yamzon, Johnathon ; Petrone, Patrizio ; Asensio, Juan A. ; Velmahos, George C. / Intrapleural thrombolysis for the management of undrained traumatic hemothorax : A prospective observational study. In: Journal of Trauma - Injury, Infection and Critical Care. 2007 ; Vol. 62, No. 5. pp. 1175-1178.
@article{508075549071481d88852b3c451f6d65,
title = "Intrapleural thrombolysis for the management of undrained traumatic hemothorax: A prospective observational study",
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.",
author = "Kimbrell, {Brian J.} and Johnathon Yamzon and Patrizio Petrone and Asensio, {Juan A.} and Velmahos, {George C.}",
year = "2007",
month = "5",
doi = "10.1097/TA.0b013e3180500654",
language = "English",
volume = "62",
pages = "1175--1178",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

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 -