Abstract

Background: Intrapleural lytic therapy has been established as an important modality of treatment for many pleural disorders, including hemothorax and empyema. Retained traumatic hemothorax is a common and understudied subset of pleural disease. The current standard of care for retained traumatic hemothorax is operative management. The use of lytic therapy for avoidance of operative intervention in the trauma population has not been well established. Methods: Randomized controlled trials (RCTs) and non-RCTs reporting operative intervention following the use of intrapleural lytic treatment for retained traumatic hemothorax were identified in the literature. The primary outcome was avoidance of surgery following treatment with any lytic agent. Meta-analysis was performed to pool the results of those studies. Subgroup analysis by type of lytic therapy and analysis of length of stay were also performed. Results: One RCT and nine non-RCTs including 162 patients were pooled in the analysis. Avoidance of surgery following treatment with any lytic agent was found to be 87% (95% CI, 81%-92%). Tissue plasminogen activator resulted in 83% operative avoidance (95% CI, 71%-94%), and other, non-tissue plasminogen activator lytic agents resulted in 87% operative avoidance (95% CI, 82%-93%). The average length of stay for patients undergoing lytic therapy was 14.88 days (95% CI, 12.88-16.88). Conclusions: Lytic therapy could reduce the need for operative intervention in trauma patients with retained traumatic hemothorax. RCTs are indicated to definitively evaluate the benefit of this approach.

Original languageEnglish (US)
Pages (from-to)805-815
Number of pages11
JournalCHEST
Volume155
Issue number4
DOIs
StatePublished - Apr 1 2019

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Hemothorax
Meta-Analysis
Therapeutics
Randomized Controlled Trials
Length of Stay
Pleural Diseases
Empyema
Plasminogen Activators
Wounds and Injuries
Tissue Plasminogen Activator
Standard of Care

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{d0f8064db8f94632895f35b75d7ca268,
title = "Lytic Therapy for Retained Traumatic Hemothorax: A Systematic Review and Meta-analysis",
abstract = "Background: Intrapleural lytic therapy has been established as an important modality of treatment for many pleural disorders, including hemothorax and empyema. Retained traumatic hemothorax is a common and understudied subset of pleural disease. The current standard of care for retained traumatic hemothorax is operative management. The use of lytic therapy for avoidance of operative intervention in the trauma population has not been well established. Methods: Randomized controlled trials (RCTs) and non-RCTs reporting operative intervention following the use of intrapleural lytic treatment for retained traumatic hemothorax were identified in the literature. The primary outcome was avoidance of surgery following treatment with any lytic agent. Meta-analysis was performed to pool the results of those studies. Subgroup analysis by type of lytic therapy and analysis of length of stay were also performed. Results: One RCT and nine non-RCTs including 162 patients were pooled in the analysis. Avoidance of surgery following treatment with any lytic agent was found to be 87{\%} (95{\%} CI, 81{\%}-92{\%}). Tissue plasminogen activator resulted in 83{\%} operative avoidance (95{\%} CI, 71{\%}-94{\%}), and other, non-tissue plasminogen activator lytic agents resulted in 87{\%} operative avoidance (95{\%} CI, 82{\%}-93{\%}). The average length of stay for patients undergoing lytic therapy was 14.88 days (95{\%} CI, 12.88-16.88). Conclusions: Lytic therapy could reduce the need for operative intervention in trauma patients with retained traumatic hemothorax. RCTs are indicated to definitively evaluate the benefit of this approach.",
author = "Hendriksen, {Brandon S.} and Kuroki, {Marcos T.} and Scott Armen and Reed, {Michael F.} and Taylor, {Matthew D.} and Hollenbeak, {Christopher S.}",
year = "2019",
month = "4",
day = "1",
doi = "10.1016/j.chest.2019.01.007",
language = "English (US)",
volume = "155",
pages = "805--815",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
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}

Lytic Therapy for Retained Traumatic Hemothorax : A Systematic Review and Meta-analysis. / Hendriksen, Brandon S.; Kuroki, Marcos T.; Armen, Scott; Reed, Michael F.; Taylor, Matthew D.; Hollenbeak, Christopher S.

In: CHEST, Vol. 155, No. 4, 01.04.2019, p. 805-815.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Lytic Therapy for Retained Traumatic Hemothorax

T2 - A Systematic Review and Meta-analysis

AU - Hendriksen, Brandon S.

AU - Kuroki, Marcos T.

AU - Armen, Scott

AU - Reed, Michael F.

AU - Taylor, Matthew D.

AU - Hollenbeak, Christopher S.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: Intrapleural lytic therapy has been established as an important modality of treatment for many pleural disorders, including hemothorax and empyema. Retained traumatic hemothorax is a common and understudied subset of pleural disease. The current standard of care for retained traumatic hemothorax is operative management. The use of lytic therapy for avoidance of operative intervention in the trauma population has not been well established. Methods: Randomized controlled trials (RCTs) and non-RCTs reporting operative intervention following the use of intrapleural lytic treatment for retained traumatic hemothorax were identified in the literature. The primary outcome was avoidance of surgery following treatment with any lytic agent. Meta-analysis was performed to pool the results of those studies. Subgroup analysis by type of lytic therapy and analysis of length of stay were also performed. Results: One RCT and nine non-RCTs including 162 patients were pooled in the analysis. Avoidance of surgery following treatment with any lytic agent was found to be 87% (95% CI, 81%-92%). Tissue plasminogen activator resulted in 83% operative avoidance (95% CI, 71%-94%), and other, non-tissue plasminogen activator lytic agents resulted in 87% operative avoidance (95% CI, 82%-93%). The average length of stay for patients undergoing lytic therapy was 14.88 days (95% CI, 12.88-16.88). Conclusions: Lytic therapy could reduce the need for operative intervention in trauma patients with retained traumatic hemothorax. RCTs are indicated to definitively evaluate the benefit of this approach.

AB - Background: Intrapleural lytic therapy has been established as an important modality of treatment for many pleural disorders, including hemothorax and empyema. Retained traumatic hemothorax is a common and understudied subset of pleural disease. The current standard of care for retained traumatic hemothorax is operative management. The use of lytic therapy for avoidance of operative intervention in the trauma population has not been well established. Methods: Randomized controlled trials (RCTs) and non-RCTs reporting operative intervention following the use of intrapleural lytic treatment for retained traumatic hemothorax were identified in the literature. The primary outcome was avoidance of surgery following treatment with any lytic agent. Meta-analysis was performed to pool the results of those studies. Subgroup analysis by type of lytic therapy and analysis of length of stay were also performed. Results: One RCT and nine non-RCTs including 162 patients were pooled in the analysis. Avoidance of surgery following treatment with any lytic agent was found to be 87% (95% CI, 81%-92%). Tissue plasminogen activator resulted in 83% operative avoidance (95% CI, 71%-94%), and other, non-tissue plasminogen activator lytic agents resulted in 87% operative avoidance (95% CI, 82%-93%). The average length of stay for patients undergoing lytic therapy was 14.88 days (95% CI, 12.88-16.88). Conclusions: Lytic therapy could reduce the need for operative intervention in trauma patients with retained traumatic hemothorax. RCTs are indicated to definitively evaluate the benefit of this approach.

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U2 - 10.1016/j.chest.2019.01.007

DO - 10.1016/j.chest.2019.01.007

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VL - 155

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JF - Chest

SN - 0012-3692

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