Do vented chest seals differ in efficacy? An experimental evaluation using a swine hemopneumothorax model.

Objective: Hemopneumothorax (HPTX) is the second leading cause of potentially preventable death among combat casualties. We investigated the ability of five FDA-approved non-occlusive chest seals (CSs) to seal a bleeding chest wound and prevent tension HPTX in a swine model. Methods: Following instrumentation, an open chest wound was created in the left thorax of spontaneously air-breathing anesthetized pigs (n=26, 43 Kg). Autologous fresh blood (226 mL) was then infused into the pleural cavity to produce HPTX. The chest wounds were then sealed with CSs. The sealant strength and venting function of CSs were challenged by infusion of 50 mL more blood directly into the chest wound and incremental air injections into the pleural cavity. Tension HPTX was defined as intrapleural (IP) pressure >= +1 mmHg and >20% deviation in physiological measurements. Results: An open chest wound with HPTX raised IP pressure (~ -0.7 mmHg) and caused labored breathing and reductions in PaO2 and SvO2 (P

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