Relevant Publications
Thoracic Irrigation & CLR Use for Hemothorax Management
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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 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.
Zambetti 2022. Patients requiring VATS for retained hemothorax had similarly long hospital LOS (14 days) and ICU LOS (4 days) as found by Prakash 2020.
Wong 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.
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Thoracic irrigation with CLR is associated with decreased odds of retained hemothorax requiring secondary intervention; fewer chest tube days; and zero safety events.
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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.
Al Tannir 2024. Medical College of Wisconsin’s 5-year experience with thoracic irrigation: Lower retained HTX (10% vs 21%); lower rate of VATS (6% vs 19%); shorter chest tube duration (4 vs. 6 days); shorter hospital LOS (8 vs. 10 days).
Carver 2024. 11-center, prospective observational study. 493 hemithoraces. 44% decrease in the odds of requiring a secondary intervention (e.g., second chest tube, operative management) for retained hemothorax in the irrigation group.
Crankshaw 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.
Kugler 2017. Thoracic irrigation associated with 84% lower odds of requiring a of secondary intervention for retained hemothorax: 5.6% vs. 21.8% for standard therapy patients (p<0.001). No difference in thoracic infections.
Kugler 2016. Thoracic irrigation associated with 75% reduction in secondary intervention for retained hemothorax in this pilot study: 5% vs. 20% for standard therapy patients.
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Orlando Regional Medical Center’s Hemothorax Management Algorithm. Early and repeated (as needed) CLR-enabled thoracic irrigation is incorporated into ORMC’s standard hemothorax management.
Western Trauma Association. Thoracic irrigation is incorporated in the WTA’s hemothorax management algorithm.
McLauchlan 2024. 9-patient series of thoracic irrigation via 14F pigtail.
“Specialized devices, such as the CLR Irrigator… can allow for more ergonomic lavage as well as the ability to rapidly cycle between irrigation and suction… [and] may agitate and more effectively dilute the traumatic HTX, theoretically inhibiting coagulation. Cycling irrigation may also help to clear mild obstructions formed during suction…”
Episode 732, 2024. Hot Topics in Trauma: Western Trauma Association 2024.
“I’ll be honest with you, when we started the whole process [of thoracic irrigation] there was a lot of resistance. But [now]… we like it, we love it…” (Univ Med Center, New Orleans, re: CLR use)