Lung Function in Patients Operated for Chronic Pleural Empyema

Rzyman, Witold; Skokowski, Jan; Romanowicz, Grzegorz; Lass, Piotr; Murawski, Maciej; Taraszewska, M; Dziadziuszko, Rafał

doi:10.1055/s-2005-837646

Cited by 12 publications

(13 citation statements)

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“…Although open surgery still is a method that achieves excellent results in terms of completely resolving pleural empyema in advaced stages [12,13], its indications are now limited by its invasive nature. However, decortication by thoracotomy remains the procedure of choice for the treatment of pleural empyema, and must be the procedure to use when VATS is not sufficient.…”

Section: Discussionmentioning

confidence: 99%

“…Although based on a limited number of cases, a prospective study of patients treated with open surgery reported by Rzyman et al [13] showed a moderate reduction in pulmonary function. The VATS results reported by Cassina et al [3] and those in the current study confirm that also with VATS, the reduction of ventilation is acceptable in 86% to 90% of cases.…”

Section: Discussionmentioning

confidence: 99%

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Video-assisted thoracic surgery in the treatment of pleural empyema

2007

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Video-assisted thoracic surgery in the treatment of pleural empyema

2007

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“…In spite of improvement in values, the function of the affected lung remains impaired [46]. The remaining ventilation/ perfusion mismatch is due to multilevel functional lung damage [47]. In patients with a longstanding posttuberculotic collapsed lung with minimal perfusion, decortication can be attempted but the outcome is unpredictable [48].…”

Section: Decorticationmentioning

confidence: 98%

“…In patients with a longstanding posttuberculotic collapsed lung with minimal perfusion, decortication can be attempted but the outcome is unpredictable [48]. As far as the patient is symptomatic, the benefit of the procedure is proven (2b) [45][46][47][48][49]. However, decortication is not indicated and observation is warranted for asymptomatic patients [50].…”

Section: Decorticationmentioning

confidence: 99%

Current surgical treatment of thoracic empyema in adults

Molnár¹

2007

European Journal of Cardio-Thoracic Surgery

208

182

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A review of the recent literature on treatment modalities of adult thoracic empyema was conducted in order to expose the controversies and verify where consensus exists. Critical reading filtered through clinical experience was the method followed. The roles of surgical drainage, lavage techniques, debridement via VATS, decortication, thoracoplasty and open window thoracostomy were considered using the Oxford Center of Evidence Based Medicine criteria. The roles of the different therapeutical modalities were interpreted in the light of the triphasic nature of empyema thoracis. The randomised controlled trials came up with conflicting results. With two exceptions all of the papers reviewed provide level (2b) or below evidences. The lack of a single ideal treatment modality or policy reflects the complexity of the diagnosis and staging of this heterogeneous disease. Basic elements of intervention--drainage, different evacuation techniques, decortication, thoracoplasty and open window thoracostomy--are well-established technical modalities; however, neither a universally acceptable primary modality nor the gold standard of their sequence is available. Drainage remains to be the initial treatment modality in Phase I disease. Debridement via VATS is a safe, reliable and efficient method in the fibrinopurulent phase. Organised pleural callus requires formal decortication. Open window thoracostomy is a simple and safe procedure for high-risk patients and results in quick detoxication. Thoracoplasty kept its final role in pleural space management. Acute postoperative bronchial stump insufficiency requires immediate surgery. Evacuation of toxic material is mandatory. No single-stage procedure offers a solution. An optimised agressivity treatment modality should be tailored to the condition of the patient and to the potential of the persisting cavity. Decision-making involves a triad consisting of the aetiology of empyema (i.e. primary vs secondary), general condition of the patient and stage of disease, while considering the triphasic nature of development of thoracic empyema. The current attitudes show that the present concepts are based mainly on expert opinion. Flexibility and patience on behalf of the surgeon and nursing staff, the patient and the hospital management, as well as a good understanding of the complexity of this condition are the cornerstones of the treatment. No exclusive sequence of procedures leading to a uniformly predictable successful outcome is available. Individualised approaches can be recommended based on institutional practice and local protocols. Thoracic empyema in general seems to remain resilient to fit completely into the categories of evidence-based medical approach.

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“…Releasing the trapped lung improves pulmonary perfusion and improves forced vital capacity (FVC) from 61% up to 77% and forced expiratory volume in 1 second (FEV1) from 61% to 78%. 30,31 Its value has been demonstrated in decortication of trapped lung in tuberculous empyema. 32 Similar improvement is seen after decortication to release trapped lung in patients after cardiac surgery with improvement in their dyspnea score and lung capacity.…”

Section: Results Of Decortication For Benign Trapped Lung Open Decortmentioning

confidence: 98%