The effect of both tube diameter and irrigation volume on retained HEMOTHORAX after thoracic irrigation in swine.

Abstract

Research supports the use of thoracic irrigation to decrease retained hemothorax (rHTX) rates; however, the efficacy of irrigation through pigtail (14 Fr) thoracostomy tubes (TTs) and the optimal volume of irrigation are not known. This study evaluated thoracic irrigation via 14 Fr and 28 Fr TT in a swine hemothorax model to evaluate the effect of tube size and volume of irrigation on rHTX. We hypothesized that 28 Fr TT and 3 L of irrigation would be associated with decreased rHTX volume. Female Yorkshire/Landrace cross swine (40-55 kg) were used in this study. Bilateral 500 mL hemothoraces were created and allowed to dwell in each chest for 4 hours. Each animal underwent placement of a 28-Fr chest tube in one randomly assigned hemithorax and a 14-Fr pigtail catheter the other. Each thorax was irrigated with 1 L (10 animals/group) or 3 L (10 animals/group) of saline using a CLR™ irrigation device. After 2 hours of pleural drainage the animals were euthanized, and a thoracotomy performed to quantify the volume of rHTX. rHTX volume after 1 L of irrigation was 176 mL vs. 78 mL for the 14- and 28-Fr TT, respectively ( p < 0.01). Following 3 L of irrigation, the rHTX volume was 194 mL vs. 79 mL for the 14- and 28-Fr TT groups, respectively ( p < 0.001). No significant difference was found in rHTX rates between 1 L and 3 L groups regardless of TT size. Total procedure time was significantly longer in the 14-Fr group in 1 L (458 seconds vs. 225 seconds, p < 0.001) and 3 L experiments (1,077 vs. 605 seconds, p < 0.01). The use of 28 Fr TT resulted in reduced volume of rHTX after thoracic irrigation when compared with 14 Fr TT but irrigation volume > 1 L did not reduce the amount of rHTX.