Hemothorax surgery
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Hemothorax Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Hemothorax surgery On the Web |
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American Roentgen Ray Society Images of Hemothorax surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Irfan Dotani Joanna Ekabua, M.D. [2]
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Overview
The successful management of hemothorax depends on the severity of the blood loss and subsequent hemodynamic stability of the patient. The mainstay of therapy for a hemothorax is intercostal chest drain (ICD) and oxygen therapy that significantly reduce the morbidity and mortality. Evacuation of haemothorax by chest tube does not succeed in all cases. The resultant retained intrapleural collections are referred to as residual hemothorax (RH). Blood in the pleural cavity may organize and fibrosis, resulting in a loss of lung volume and empyema if untreated. Video assisted thoracic surgery (VATS), minimally invasive surgery, has been found to be highly successful for the treatment of these residual collections, especially when used early. VATS also can be used to treat patients with active blood loss but with stable hemodynamics, not only to stop the bleeding but also to evacuate blood clots and break down adhesions to prevent fibrothorax and restrictive physiology. An optimal period between the start of haemothorax and VATS of 48–72 hrs is repeatedly advocated and longer intervals lead to increased rates of complications, according to some authors. A longer time span increases the chance of intraoperative conversion to thoracotomy, prolongs postoperative drainage time and is associated with a higher incidence of hospital admissions. Thoracotomy with ongoing resuscitation is the procedure of choice for patients with hemodynamic instability due to massive haemothorax or active bleeding. The criteria for thoracotomy, are blood loss by chest tube of 1.500 ml in 24 h or 200 ml per hour during several successive hours and the need for repeated blood transfusions to maintain hemodynamic stability. Surgical exploration allows control of the source of bleeding and evacuation of the intrathoracic blood; and also is required for adequate empyema drainage and/or decortication.
Surgery
- Intercostal chest drain (ICD)
- Video assisted thoracic surgery (VATS)
- Thoracotomy