Standard chest tube drainage does not reliably clear traumatic hemothorax. In a significant number of cases, blood remains in the pleural space long after the tube is placed, and that retained collection becomes its own clinical problem.
How Common Is Retained Hemothorax?
In the same 17-center study, among patients with retained hemothorax, total hospital length of stay ran 7 days longer than patients without a retained collection. ICU length of stay was 3 days longer, pneumonia was more common, and functional outcomes were worse both at hospital discharge and at first outpatient follow-up.
67.0% (71 of 106 patients) with retained hemothorax needed a second intervention to clear the retained collection, such as video-assisted thoracoscopic surgery, thoracotomy or intrapleural fibrinolytic therapy.
The Impact of Retained Hemothorax
In the same 17-center study, among patients with retained hemothorax, total hospital length of stay ran 7 days longer than patients without a retained collection. ICU length of stay was 3 days longer, pneumonia was more common, and functional outcomes were worse both at hospital discharge and at first outpatient follow-up.
67.0% (71 of 106 patients) with retained hemothorax needed a second intervention to clear the retained collection, such as video-assisted thoracoscopic surgery, thoracotomy or intrapleural fibrinolytic therapy.
Why This Is Also an Operational Problem
Retained hemothorax not only produces worse outcomes for the patient, it also affects the hospital more broadly across multiple points of care.
Added length of stay, particularly in the ICU, has a cascading effect on other parts of the hospital. When beds are held longer than expected, the emergency department and post-anesthesia care unit are pressed into service as informal holding areas for patients waiting on a bed, which delays or degrades the care those spaces are designed to deliver. The result is longer waits for emergency services and delayed start times for scheduled OR cases.
Each VATS or thoracotomy performed to clear a retained collection consumes OR time. Including anesthesia time and room turnover, retained hemothorax that requires operative management may steal hours from scheduled procedures.
For trauma centers managing volume, particularly during high-acuity seasons, retained hemothorax depletes finite hospital resources and represents a recurring, quantifiable cost across the hospital rather than an occasional outlier.
Thoracic Irrigation as a Preventative Approach
Over the last 10 years, early thoracic irrigation has been shown to result in more effective and complete hemothorax evacuation. The reduction in retained hemothorax has led to quantifiable benefits.
A systematic review and meta-analysis from the University of Miami Miller School of Medicine demonstrated that irrigation was associated with
- >40% lowering of retained hemothorax that required treatment
- 3 days less overall hospital stay
- 3 days less in the ICU
- $90k lower mean cost of the hospital stay
- 38% less infectious complications
Source: Lyons 2025
It is important to note that the effectiveness of thoracic irrigation as a preventative strategy is measured in both clinical / individual patient-oriented outcomes and hospital-wide operational end points.
Of further interest is that hospitals that fully protocolize irrigation may realize even greater reductions in the complication of retained hemothorax. For example, the Medical College of Wisconsin has reported 50-75+% reduction in retained hemothorax with early irrigation.
Source: Kugler 2017, Al Tannir 2024
Learn more: CLR Medical publications
The Takeaway for Trauma Teams
Retained hemothorax is common, expensive, and largely preventable if early irrigation is added just after chest tube placement.
The next question for most trauma programs is a practical one: What does it take to irrigate the pleural space at the bedside, efficiently, cleanly, and without overly disrupting existing workflows? That is the subject of the next post in this series, which looks at how CLR Medical’s device platform makes protocolized thoracic irrigation cost-effective and feasible in trauma bays, OR’s, ICUs, and elsewhere in the hospital.
See how CLR enables thoracic irrigation: clrmedical.com