McLauchlan Nathaniel R, Igra Noah M, Fisher Lydia T, Byrne James P, Beyer Carl A, Geng Zhi, Schmulevich Daniela, Brinson Martha M, Dumas Ryan P, Holena Daniel N, Hynes Allyson M, Rosen Claire B, Shah Amit N, Vella Michael A, Cannon Jeremy W
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Trauma Surg Acute Care Open. 2023 Mar 20;8(1):e001050. doi: 10.1136/tsaco-2022-001050. eCollection 2023.
To quantify and assess the relative performance parameters of thoracic lavage and percutaneous thoracostomy (PT) using a novel, basic science 2×2 randomized controlled simulation trial.
Treatment of traumatic hemothorax (HTX) with open tube thoracostomy (TT) is painful and retained HTX is common. PT is potentially less painful whereas thoracic lavage may reduce retained HTX. Yet, procedural time and the feasibility of combining PT with lavage remain undefined.
A simulated partially clotted HTX (2%-gelatin-saline mixture) was loaded into a TT trainer and then evacuated after randomization to one of four protocols: TT+/-lavage or PT+/-lavage. Standardized inserts with fixed 28-Fr TT or 14-Fr PT positioning were used to minimize tube positioning variability. Lavage consisted of two 500 mL aliquots of warm saline after initial HTX evacuation. The primary outcome was HTX volume evacuated. The secondary outcome was additional procedural time required for the addition of the lavage.
A total of 40 simulated HTX trials were randomized. TT alone evacuated a median of 1236 mL (IQR 1168, 1294) leaving a residual volume of 265 mL (IQR 206, 333). PT alone resulted in a significantly greater median residual volume of 588 mL (IQR 497, 646) (p=0.002). Adding lavage resulted in similar residual volumes for TT compared with TT alone but significantly less for PT compared with PT alone (p=0.002). Lavage increased procedural time for TT by a median of 7.0 min (IQR 6.5, 8.0) vs 11.7 min (IQR 10.2, 12.0) for PT (p<0.001).
This simulation trial characterized HTX evacuation in a standardized fashion. Adding lavage to thoracostomy placement may improve evacuation, particularly for small-diameter tubes, with little added procedural time. Further prospective clinical study is warranted.
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通过一项新颖的基础科学2×2随机对照模拟试验，量化并评估胸腔灌洗和经皮胸腔造口术（PT）的相对性能参数。
采用开放式胸腔造口术（TT）治疗创伤性血胸（HTX）很痛苦，残留HTX很常见。PT可能疼痛较轻，而胸腔灌洗可能减少残留HTX。然而，操作时间以及PT与灌洗联合应用的可行性仍不明确。
将模拟的部分凝固性HTX（2%明胶-盐水混合物）装入TT训练器，随机分为四种方案之一后进行排空：TT±灌洗或PT±灌洗。使用带有固定28-F TT或14-F PT定位的标准化插入物，以尽量减少导管定位的变异性。灌洗包括在最初排空HTX后分两次注入500 mL温盐水。主要结局是排出的HTX体积。次要结局是增加灌洗所需的额外操作时间。
共随机进行了40次模拟HTX试验。单独使用TT排出的中位数为1236 mL（IQR 1168，1294），残留体积为265 mL（IQR 206，333）。单独使用PT导致的中位数残留体积显著更大，为588 mL（IQR 497，646）（p = 0.002）。与单独使用TT相比，添加灌洗后TT的残留体积相似，但与单独使用PT相比，PT的残留体积显著更小（p = 0.002）。灌洗使TT的操作时间中位数增加7.0分钟（IQR 6.5，8.0），而PT为11.7分钟（IQR 10.2，12.0）（p < 0.001）。
该模拟试验以标准化方式描述了HTX的排空情况。在胸腔造口术放置时添加灌洗可能会改善排空效果，特别是对于小直径导管，且增加的操作时间很少。有必要进行进一步的前瞻性临床研究。
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