Prone Positioning to Facilitate Hemothorax Drainage During Chest Tube Management: Case Series and Practical Experience

Chest trauma is one of the leading causes of hemothorax, defined as the presence of blood within the pleural space or as a pleural fluid hematocrit greater than 50%. Hemorrhage may originate from multiple structures, including the chest wall, pulmonary parenchyma, and major vessels. Management ranges from clinical observation to invasive interventions, such as tube thoracostomy, video-assisted thoracoscopic surgery (VATS), or open thoracotomy, depending on the severity of injury and the patient’s clinical course [1].Hemothorax may evolve through two distinct pathophysiological stages: early and late. In the early stage, defibrination of pleural blood occurs, associated with increased protein concentration in the pleural fluid and elevated intrapleural osmotic pressure, favoring pleural effusion formation. Under usual conditions, volumes smaller than 300 mL tend to be spontaneously reabsorbed over several weeks. However, when resorption fails, the condition may progress to retained hemothorax (RH), which can develop as early as the first 24 hours following chest tube placement. The reported incidence of RH ranges from 5% to 30%, and a significant proportion of affected patients ultimately require surgical intervention [1].In trauma referral centers, hospitalization of multiple patients with hemothorax secondary to chest trauma is common, with management strategies including both conservative treatment and tube thoracostomy. During my practice in a surgical ward, bedside thoracic ultrasound revealed that some patients continued to present moderate pleural effusions 3 to 5 days after chest tube placement, despite apparently functioning drains and low daily output (