Therapy
In order to ensure that therapy is effective, the cause of the hematothorax should first be determined. If this involves injuries to vessels or organs, these should be treated first in order to prevent greater blood loss and to keep the accumulation of blood in the thorax as low as possible. The next measure should be a so-called thoracic drainage.
This is a tube system that is placed from the outside between the two pleural leaves and directly into the effusion. This drainage should allow the blood to flow out of the thorax. In addition, a valve can be attached to the drainage, which pulls out the remaining fluid with a suction.
In addition to the draining function, the drainage can also be used to flush the pleural gap in order to remove all residual effusion. The rinsing solution can be mixed with antibiotics to minimize the risk of local inflammation. The thoracic drainage is applied through an approximately 2-3 cm large skin incision in an intercostal space, the subcutaneous fatty tissue is displaced with blunt scissors.
Once the pleura is opened, the drainage can be advanced into the thoracic cavity. It is fixed in place with a skin suture. The drainage is often located in the space between the 4th and 5th rib on the lateral thorax, this technique is called Bülau drainage.
However, it can also be applied further up. If the hematothorax is due to vascular or organ injury or if there is a traumatic injury to the thorax from the outside, a thoracotomy can be performed as therapy. This is a surgical opening of the thorax.
For this purpose, the patient is usually positioned on his or her side and the injury can be treated surgically within the thoracic cavity via various access routes. In addition, the hematothorax, i.e. the accumulation of blood, can be completely suctioned out and removed via this access route. This prevents the hardening of the effusion and the resulting sticking of the pleura together. During this operation it is also possible to apply a thoracic drainage from the inside. In addition to these invasive measures, a prophylactic antibiotic therapy should be carried out over a period of several weeks to prevent bacteria from settling in the thoracic cavity and resulting inflammation.
