Treatment of haemothorax

Summary Haemothorax is a problem commonly encountered in medical practice and is most frequently related to open or closed chest trauma or to invasive procedures of the chest. Spontaneous haemothorax is less common and can have various causes, such as the use of anticoagulants, neoplasia, and ruptur...

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Bibliographic Details
Published in:Respiratory medicine 2010-11, Vol.104 (11), p.1583-1587
Main Authors: Boersma, Wim G, Stigt, Jos A, Smit, Hans J.M
Format: Article
Language:English
Subjects:
Algorithms
Anti-Bacterial Agents - therapeutic use
Antibiotic prophylaxis
Biological and medical sciences
Chest tube
Chest Tubes
Computerized tomography
Evacuations & rescues
Fibrinolytic therapy
Haemothorax
Hemothorax - diagnosis
Hemothorax - etiology
Hemothorax - therapy
Humans
Medical sciences
Ostomy
Pneumology
Pulmonary arteries
Pulmonary/Respiratory
Respiratory system : syndromes and miscellaneous diseases
Studies
Surgery
Thoracic Injuries - complications
Thoracotomy - methods
Thrombolytic Therapy - methods
Trauma
Veins & arteries
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Summary:Summary Haemothorax is a problem commonly encountered in medical practice and is most frequently related to open or closed chest trauma or to invasive procedures of the chest. Spontaneous haemothorax is less common and can have various causes, such as the use of anticoagulants, neoplasia, and rupture of pleural adhesions. Identification by radiography and thoracentesis is indicated and treatment of the underlying trauma should start immediately. After insertion of a large chest tube, antibiotic prophylaxis in trauma patients should be administered for 24 h. Further treatment depends on the haemodynamic stability of the patient, the volume of evacuated blood and the occurrence of persistent blood loss. Surgical exploration by VATS or thoracotomy is necessary if >1.500 ml of blood has accumulated and/or an ongoing production of >200 ml of blood per hour is observed. If the haemorrhage is less severe, careful investigation into the underlying cause must be performed and blood should be evacuated by tube thoracostomy. If clotted blood retained in spite of tube thoracostomy, intrapleural fibrinolytic therapy can be applied to breakdown clots and adhesions. If conservative treatment is insufficient, a surgical approach with VATS or thoracotomy is indicated to prevent subsequent complications.
ISSN:0954-6111
1532-3064
DOI:10.1016/j.rmed.2010.08.006