Abstract
Retained hemothorax following thoracic trauma remains a difficult problem to manage. Multiple studies have demonstrated the association between retained hemothorax and negative patient outcomes. A significant body of literature exists regarding specific treatment strategies and the optimal time period for intervention. Fewer studies have assessed the impact of specific variables and strategies during the initial tube thoracostomy and their relation to subsequent development of retained hemothorax. Analysis of factors such as chest tube size, expertise of practitioner, and chest tube position has not yielded significant actionable data to change practice patterns or decrease the incidence of retained hemothorax. A technique that has gained interest in recent years involves irrigating the thoracic cavity with normal saline at the time of initial tube thoracostomy for traumatic hemothorax. This procedure is utilized by many trauma surgeons but has only been studied in a few small series to date. This chapter addresses the data on this preventative measure and attempts to determine if this practice can be recommended based on currently available evidence.