Retrospective Evaluation of Intrapleural Tissue Plasminogen Activator With or Without Dornase Alfa for the Treatment of Traumatic Retained Hemothorax: A 6-Year Experience

Janowak, Christopher F.; Becker, Bradley Robert; Philpott, Carolyn; Makley, Amy T.; Mueller, Eric; Droege, Christopher

doi:10.1177/10600280221077383

Cited by 1 publication

(1 citation statement)

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“…While the use of IPFT is inherently appealing as a pharmacologic alternative to surgery, the approach is disadvantaged by the paucity of literature defining the optimal fibrinolytic agents to be used for RH, their dosing, and their schedules of administration, as is the case in empyema [ 19 , 20 ]. While understudied, one report suggested that the addition of DNase to tPA did not improve the outcomes of RH [ 21 ]. Whether the same forms of IPFT should be used for cases of RH as for empyema remains unclear.…”

Section: Introductionmentioning

confidence: 99%

A Novel Rabbit Model of Retained Hemothorax with Pleural Organization

De Vera,

Emerine,

Girard

et al. 2023

IJMS

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Retained hemothorax (RH) is a commonly encountered and potentially severe complication of intrapleural bleeding that can organize with lung restriction. Early surgical intervention and intrapleural fibrinolytic therapy have been advocated. However, the lack of a reliable, cost-effective model amenable to interventional testing has hampered our understanding of the role of pharmacological interventions in RH management. Here, we report the development of a new RH model in rabbits. RH was induced by sequential administration of up to three doses of recalcified citrated homologous rabbit donor blood plus thrombin via a chest tube. RH at 4, 7, and 10 days post-induction (RH4, RH7, and RH10, respectively) was characterized by clot retention, intrapleural organization, and increased pleural rind, similar to that of clinical RH. Clinical imaging techniques such as ultrasonography and computed tomography (CT) revealed the dynamic formation and resorption of intrapleural clots over time and the resulting lung restriction. RH7 and RH10 were evaluated in young (3 mo) animals of both sexes. The RH7 recapitulated the most clinically relevant RH attributes; therefore, we used this model further to evaluate the effect of age on RH development. Sanguineous pleural fluids (PFs) in the model were generally small and variably detected among different models. The rabbit model PFs exhibited a proinflammatory response reminiscent of human hemothorax PFs. Overall, RH7 results in the consistent formation of durable intrapleural clots, pleural adhesions, pleural thickening, and lung restriction. Protracted chest tube placement over 7 d was achieved, enabling direct intrapleural access for sampling and treatment. The model, particularly RH7, is amenable to testing new intrapleural pharmacologic interventions, including iterations of currently used empirically dosed agents or new candidates designed to safely and more effectively clear RH.

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Section: Introductionmentioning

confidence: 99%