Thoracic Irrigation & CLR Use for Hemothorax Management
Retained hemothorax is common with standard chest drainage; frequently requires secondary interventions (e.g., lytics, VATS); and is associated with greater hospital length of stay and increased hospital costs.
Prakash et al. (2020): In this 17-center study, 29% of patients with traumatic hemothorax developed retained hemothorax (ret. HTX) with standard management, 67% of these requiring secondary intervention. On average, patients with ret. HTX had 7 days longer hospital LOS, 3 days longer ICU LOS, increased ventilator days, and worse functional outcomes.
Wong et al. (2022): Average increase in hospital costs associated with retained hemothorax management: lytics only $9,200, VATS only $10,700, open thoracotomy only $18,300. Costs higher if multiple interventions required.
Thoracic irrigation with CLR is associated with decreased odds of retained hemothorax requiring secondary intervention; fewer chest tube days; and zero safety events.
Thoracic irrigation for hemothorax management is guideline-supported and associated with a decreased rate of retained hemothorax requiring secondary intervention, shorter hospital length of stay, and lower hospital charges.
Kugler et al. (2017): Thoracic irrigation associated with lower rate of secondary intervention (e.g., second chest tube, operative management) for retained hemothorax: 5.6% vs. 21.8% for standard therapy patients (p<0.001). No difference in thoracic infections.
Crankshaw et al (2022): Thoracic irrigation associated with 4 fewer hospital days than standard therapy (p = 0.04). When irrigated with >1000cc, patients stayed in hospital for 8 fewer days (p=0.002). Hospital charges an average of $88,000 lower in irrigated patients (p=0.02). No difference in thoracic infections.