Donaldson Ross I, Zimmermann Eric M, Buchanan Oliver J, Graham Todd L, Ross James D
Critical Innovations, Los Angeles, CA, USA.
Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
J Thorac Dis. 2021 Jan;13(1):213-219. doi: 10.21037/jtd-20-1609.
Tube thoracostomy is the definitive treatment for most significant chest trauma, including injuries resulting in pneumothorax, hemothorax, and hemopneumothorax. However, traditional chest tubes fail to sufficiently remove blood up to 20% of the time (i.e., retained hemothorax), which can lead to empyema and fibrothorax, as well as significant morbidity and mortality. Here we describe the use of a novel chest tube system in a swine model of hemothorax.
This was an intra-animal-paired, randomized-controlled study of hemothorax evacuation using the PleuraPath™ Thoracostomy System (PPTS) compared to a traditional chest tube in large Yorkshire-Landrace swine (75-85 kg). One liter of autologous whole blood was infused into each pleural cavity simultaneously with subsequent drainage from each device individually monitored for a total of 120 minutes, before the end of the experiment and necroscopy.
Six animals completed the full protocol. On average, the PPTS removed 17% more blood (P=0.049) and left 19.1% less residual hemothorax (P=0.023) as compared to the standard of care during the first two hours of use. No complications or iatrogenic injury were identified in any animal for either device.
The novel PPTS device was superior to the traditional chest tube drainage system in this acute, large-animal model of retained hemothorax. While this study supports clinical translation, further research will be required to assess efficacy and optimize device use in humans.
胸腔闭式引流术是治疗大多数严重胸部创伤的 definitive 治疗方法，包括导致气胸、血胸和血气胸的损伤。然而，传统胸腔引流管在高达 20% 的时间内无法充分排出血液（即残留血胸），这可能导致脓胸和纤维胸，以及显著的发病率和死亡率。在此，我们描述了一种新型胸腔引流管系统在血胸猪模型中的应用。
这是一项在大型约克夏-长白猪（75-85 千克）中进行的动物体内配对、随机对照研究，比较使用 PleuraPath™ 胸腔造口术系统（PPTS）与传统胸腔引流管进行血胸引流的效果。将一升自体全血同时注入每个胸腔，随后分别监测每个装置的引流情况，共监测 120 分钟，直至实验结束和尸检。
六只动物完成了完整的实验方案。与使用的前两小时的标准治疗相比，平均而言，PPTS 多排出了 17% 的血液（P=0.049），残留血胸减少了 19.1%（P=0.023）。两种装置在任何动物中均未发现并发症或医源性损伤。
在这个急性、大型动物残留血胸模型中，新型 PPTS 装置优于传统胸腔引流管系统。虽然这项研究支持临床转化，但仍需要进一步研究来评估其疗效并优化该装置在人体中的使用。
