Page 85 - JSOM Fall 2021

TABLE 7 Tested Chest Seals Performance by Study
Adherence Vent/Valve Function
Count Sum Mean SD Count Sum Mean SD
Hyfin Vent Chest Seal 1 3 3 0 2 5 2.5 0.707

Russell Chest Seal 2 5 2.5 0.707 1 3 3 0

Bolin Chest Seal 3 8 2.667 0.577 3 7 2.333 1.155
SAM Chest Seal With Valve 2 6 3 0 2 2 2 1.414

Asherman Chest Seal 3 4 1.333 0.577 1 3 3 0

Sentinel Chest Seal 2 2 1 0 2 3 3 0

Halo Chest Seal 1 2 2 0 1 2 1 0
Bolin Chest Seal XL 1 1 1 0 — — — —
FastBreathe Thoracic Seal 1 3 3 0 — — — —
H&H Wound Seal Kit 1 1 1 0 — — — —

Valve/Vent Efficacy in mixed venous oxygen saturation, or a 20% fall of the mean
17
Kotora et al. and Arnaud et al.’s 2008 study used the same arterial pressure or cardiac output.
19
swine model and physiologic parameters of a 20% decrease
in mean arterial pressure or a 20% increase in heart rate from Kheirabadi et al. surgically created an open pneumothorax
baseline to signify the development of a tension pneumotho- with two percutaneous catheters, one of which reemerged
rax and therefore valve/vent failure. 17,19 In both studies, the within the wound tract to simulate an actively bleeding
16
swine were prepared in the same fashion by surgically creat- wound. The second catheter allowed air and blood to be
ing an open pneumothorax into the pleural cavity and insert- injected into the pleural cavity. Approximately 10% of the
ing a catheter into the pleural space, through which air and swine’s total blood volume was then withdrawn and injected
blood were systematically injected. It is at this point that the into its pleural cavity. The area around the wound was shaved,
two studies experimental designs began to differ. Arnaud et cleaned, and dried in preparation for one of the five random-
al. placed one of their two randomized chest seals over the ized chest seals to be placed over the open wound, with the
open chest wound, and its edges were securely taped to the valve or vent directly overlying the open wound. Air and
17
swine’s skin to ensure full adherence. Kotora et al. placed one blood were injected into the pleural space and wound tract in
of their three randomized chest seals over the wound without 0.25 L and 50 mL increments, respectively, every 10 minutes.
19
additional securing efforts. Arnaud et al. and Kotora et al. The injections continued until either 2 L of air, which was the
then injected air into the intrapleural space in 60mL incre- approximate total lung capacity of the swine, was injected into
ments to a maximum of 50mL/kg in an attempt to induce the the intrapleural space, the chest seal detached from the wound,
predefined tension pneumothorax-related changes. 17,19 After a or the study-defined tension pneumothorax criteria occurred.
successful iteration involving air injections, both studies per-
formed a follow-on trial by adding blood to the intrapleural Kheirabadi et al. reported that the HyfinVent Chest Seal, Rus-

space. Arnaud et al. removed 240mL of fresh blood, and Ko- sell Chest Seal, and Sentinel Chest Seals’ vents allowed blood

tora et al. removed 10% of the total circulatory volume from and air to escape the intrapleural space, preventing failure.
their swine. 17,19 After the blood was injected into the intrapleu- They also reported that blood clots blocked the valve mecha-
ral cavities, to create hemopneumothoraces, air injections in nisms on the Bolin Chest Seal and SAM Chest Seal With Valve

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60mL increments up to 50mL/kg were once again initiated. after the “leakage of a few milliliters of blood.” After becom-
ing occluded, the adhesive capabilities of the Bolin Chest Seal

Arnaud et al. reported no statistically significant difference be- and SAMChest Seal With Valve were eventually overwhelmed
tween the Asherman Chest Seal and Bolin Chest Seal, as they by the increasing intrapleural pressure, and they were excluded
both prevented the tension pneumothorax related-changes from further study. During two of the six iterations with the
equally well, regardless of whether the hemopneumothorax Hyfin Vent Chest Seal, adhesion failed on one side, creating a

was present. Kotora et al. reported that the Hyfin Vent Chest functional three-sided dressing. Kheirabadi et al. reported that
17

Seal, SAM Chest Seal With Valve, and Sentinel Chest Seal all the Bolin Chest Seal and SAM Chest Seal With Valve failed,

prevented any tension pneumothorax related changes with or and the HyfinVent Chest Seal, RussellChest Seal, and Sentinel
without the presence of a hemopneumothorax equally well Chest Seal as being equally successful. 16
and with no significant difference. 19
In 2013, Kheirabadi et al. compared the efficacy of an occlu-
Valve/Vent Efficacy and Adherence: sive chest seal and a nonocclusive chest seal for the treatment
Occlusive versus Nonocclusive Chest Seals of open pneumothoraces. Chest seal effectiveness was deter-
20
In 2017, Kheirabadi et al. studied chest seals as a complete mined by their ability to prevent the predefined tension pneu-
functional unit, requiring both essential attributes of effective- mothorax-related changes. Kheirabadi et al. defined those
ness to work in union. The study used a swine model with changes as an intrapleural pressure change greater than 1 mm
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a surgically-created open hemopneumothorax and an actively Hg and at least four of the following five findings: 30% in-
bleeding wound tract. The chest seals were assessed for their crease in pulmonary artery pressure, 30% decrease in mixed
ability to avoid tension pneumothorax-related physiology, de- venous oxygen saturation, 20% decrease in tidal volume, 20%
fined by the authors as an increase of intrapleural pressure by decrease in mean arterial pressure, or 20% decrease in cardiac
1 mm Hg, 30% rise of pulmonary arterial pressure, 30% fall output. 20
Chest Seals and Tension Pneumothorax Prevention | 83