Pulmonology Book

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Closed Thoracic Lavage

Aka: Closed Thoracic Lavage
  1. See Also
    1. Rewarming Methods in Hypothermia
    2. Accidental Hypothermia Management
    3. Hypothermia
    4. Chest Tube
  2. Indications
    1. Invasive Active Core Rewarming in Severe Hypothermia (core Temperature <28 to 30 C)
      1. Consider in hypothermic, pulseless arrest if extracorporeal warming not available within 6 hours
  3. Contraindications
    1. Extracorporeal blood warming (ECMO) is available
      1. Preferred method of Invasive Active Core Rewarming in Severe Hypothermia
    2. Significant Coagulopathy
    3. Lung pleura adhesions
    4. Infection overlying Chest Tube insertion sites
  4. Efficacy
    1. Raises core temp by 5.4 to 10.8 F (3 to 6 C) per hour
  5. Technique: Chest Tube Placement
    1. Typical Configuration: Two Chest Tubes
      1. In (anterior superior)
        1. Midclavicular Thoracostomy tube (second to third intercostal space)
      2. Out (posterior inferior)
        1. Midaxillary Thoracostomy tube (fourth to fith intercostal space)
    2. Alternative Configuration
      1. Single Chest Tube used to infuse, leave fluid in place and then suction fluid out
    3. Repeat on opposite side as needed
      1. Typically started on the right side
      2. Left sided lavage may increase risk for Dysrhythmia and decreased chest compression efficacy
  6. Technique: Saline Infusion
    1. Prepare Heated Sterile Normal Saline to 100.4 to 113 F (38 to 45 C, some guidelines limit to <42 C)
      1. Use commercial emergency department saline warmers (if available) OR
      2. Microwave (650 W) Normal Saline 1 liter bag
        1. Warm bag for 60 seconds and shake to agitate and distribute heat
        2. Warm bag again for another 60 seconds and shake to agitate
        3. Confirm bag Temperature at target 38 to 45 C
    2. Infuse warmed saline into anterior superior Chest Tube, and drain via posterior inferior Chest Tube
      1. Monitor Ins and Outs
  7. Technique: Completion of Thoracic Lavage
    1. Remove anterior superior Chest Tube and close the surgical wound site
    2. Leave the posterior inferior Chest Tube to allow saline to further drain
  8. Complications
    1. Acute Respiratory Distress Syndrome
    2. Pneumonia
    3. Renal Failure
    4. Dysrhythmia (left sided lavage)
    5. Decreased chest compression efficacy (left sided lavage)
  9. References
    1. Warrington (2022) Crit Dec Emerg Med 36(2): 18

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