TRAUMATIC or postoperative hemothorax should be evacuated early to approximate the pleural surfaces, preserve pulmonary function, and obviate the need for surgical decortication.1 There is always the possibility that clotting will take place despite early attempts at aspiration. Massive clotting has been reported as occurring in from four to six hours. Fibroblastic organization may begin as early as the fifth day. Experience in World War II indicated that from 15 to 20% of hemothoraces clot.2 Organizing hemothorax occurs less frequently in civilian practice.
The lysis and aspiration of a clotted hemothorax by means of an enzymatic agent would be desirable. The intrapleural injection of crystalline trypsin has been shown to produce only minimal pleural and systemic effects in animals.3 The proteolytic properties of trypsin are also well known.4
Experiments were conducted to determine the effectiveness of trypsin in the closed treatment of clotted hemothorax and also
McCROSKEY CE, HARDIN CA. TRYPTIC DÉBRIDEMENT OF CLOTTED HEMOTHORAXExperimental and Clinical Study. AMA Arch Surg. 1953;66(5):650-655. doi:10.1001/archsurg.1953.01260030669014