Suction Evacuation of Hemothorax: A Prospective Study.

Introduction: Though tube thoracostomy is a common procedure following thoracic trauma, incomplete evacuation of fluid places the patient at risk for retained hemothorax. As little as 300-500cc of blood may result in the need for an additional thoracostomy tube or, in more severe cases, lung entrapment and empyema. We hypothesized that suction evacuation of the thoracic cavity prior to tube placement would decrease the incidence of retained late complications. Methods: Patients requiring tube thoracostomy within 96 hours of admission were prospectively identified and underwent suction evacuation of the pleural space (SEPS) prior to tube placement. These patients were compared to historical controls (CON) without suction evacuation. Demographics, admission vital signs, laboratory values, details of chest tube placement and outcomes were collected on all patients. Multivariable logistic regression was utilized to compare outcomes between groups. Results: 199 patients were identified, consisting of 100 retrospective controls and 99 SEPS patients. There were no differences in age, gender, admission injury severity score or chest abbreviated injury score, admission laboratory or vital signs or hospital length of stay. Mean volume of hemothorax in SEPS patients was 220cc (SD 297); with only 48% having a volume greater than 100cc at time of tube placement. 3 patients developed empyema and 19 demonstrated retained blood; there was no difference between SEPS and CON patients. SEPS was significantly protective against recurrent pneumothorax following chest tube removal (OR 0.332; 95% CI 0.148, 0.745). Conclusion: Preemptive suction evacuation of the thoracic cavity did not have a significant impact on subsequent development of retained hemothorax or empyema. SEPS significantly decreased incidence of recurrent pneumothorax following thoracostomy removal. Though the mechanism is unclear, such a benefit may make this simple procedure worthwhile. A larger sample size is required for validation and to determine if preemptive thoracic evacuation has a clinical benefit. Levels of Evidence: Level III (Therapeutic, Care Management) (C) 2016 Lippincott Williams & Wilkins, Inc.

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