A patient in the medical intensive care unit (ICU) may be at increased risk for hemothorax. Chen et al identified risk and prognostic factors for these patients. The authors are from National Taiwan University.
Patient selection: hemothorax developing within 24 hours of an invasive procedure
91% of patients were admitted to the ICU for sepsis, pneumonia or respiratory failure
Risk factors for hemothorax:
(1) chronic kidney disease
(2) invasive procedure (thoracentesis, chest tube thoracostomy, pericardiocentesis)
Risk factors for 28-day mortality:
(1) prolonged prothrombin time (INR >= 1.6)
(2) decrease in hemoglobin concentration >= 3 g/dL
Indications for surgical intervention:
(1) persistent blood transfusion required to maintain hemodynamic stability
(2) > 1 liter of blood evacuated after tube thoracostomy
(3) bleeding > 150-200 mL per hour for 2-4 hours from tube
