Devices to Prevent and Treat Retained Hemothorax after Chest Injury

Injuries to the chest occur in about 60% of all trauma cases and roughly 90% can be treated without surgical intervention. With rib fractures or lung damage, blood often accumulates in the pleural space between the lung and the chest wall. Current treatment guidelines suggest that a tube be placed through the chest wall to drain the collection. Unfortunately, in about 15-20% of these patients, the blood is not adequately drained with initial tube placement resulting in a retained hemothorax (RH) with the potential adverse consequences of lung entrapment and empyema. Treatment of RH usually requires additional tube placement or surgical procedures to remove blood and clot. Since blood accumulates in dependent regions of the pleural space, we believe that prevention of RH is best facilitated by a "steerable" chest tube that can be placed directly into the blood collections. From this tube, extendable cannula into the pleural space can facilitate early pleural lavage and irrigation with dilute anticoagulants and thrombolytic agents. In the event of failure, we also propose the use of a novel flexible pleuroscope which can traverse the chest tube and clear the RH with direct visualization and could be inserted at the bedside with minimal sedation.