Multimodal treatment for acute empyema based on the patient’s condition, including patients who are bedridden: A single center retrospective study

Abstract

Background:The incidence of acute empyema has increased in various countries; some elderly patients with acute empyema have contraindications for surgery under general anesthesia. Therefore, suitable management based on a patient's clinical condition is required. Methods: We evaluated the different surgical and nonsurgical therapeutic approaches available for patients with acute empyema. This was a retrospective study of 57 patients with acute empyema who received treatment in our department between May 2015 and February 2019. For patients who did not initially improve with drainage or drainage combined with fibrinolytic therapy, surgery, or additional percutaneous drainage was performed based on their general condition. We compared several clinical factors pertaining to the patients who underwent surgical versus nonsurgical treatment. Results: Our study showed that the patients with a performance status of 0-2 and an American Society of Anesthesiologists physical status classification of class II or lower underwent surgery safely without major operative complications. The combination of repeated drainage of the pleural cavity and fibrinolytic therapy appeared to be a reasonable nonsurgical management option for patients in poor overall condition. Conclusion:For an aging population, we think that the combination of repeated pleural cavity drainage procedures and fibrinolytic therapy is a reasonable nonsurgical strategy for the management of patients with acute empyema.

Ultrasound‐assisted insertion of a small‐diameter thoracic catheter for acute dorsal empyema

“…First, it is possible to insert a catheter for dorsal empyema at the back and in an orthopneic position under ultrasound assistance instead of CT guidance. If the empyema is localized dorsally, the catheter is generally inserted in the prone position under CT guidance because of the difficulty identifying pleural effusions with ultrasound in the supine position 2 . In contrast, thoracentesis is commonly performed in the orthopneic position, which is the easiest position to observe and puncture a pleural effusion.…”

“…If the empyema is localized dorsally, the catheter is generally inserted in the prone position under CT guidance because of the difficulty identifying pleural effusions with ultrasound in the supine position. 2 In contrast, thoracentesis is commonly performed in the orthopneic position, which is the easiest position to observe and puncture a pleural effusion. Therefore, we used ultrasound, were able to identify pleural effusions, and successfully inserted the catheter in the orthopneic position without the need for CT guidance.…”

“…The initial treatment for acute pleural empyema includes antimicrobial therapy and pleural drainage, usually performed in the supine position 1 . However, when the empyema is localized dorsally, computed tomography (CT)‐guided drain placement is performed by an interventional radiologist (IVR) or surgeon because the difficulty of chest tube insertion is high in such cases 2 …”

“…1 However, when the empyema is localized dorsally, computed tomography (CT)-guided drain placement is performed by an interventional radiologist (IVR) or surgeon because the difficulty of chest tube insertion is high in such cases. 2 The clinical problem is that immediate drainage for empyema may be necessary even in hospitals without a surgeon or IVR practitioner.…”

“… 1 However, when the empyema is localized dorsally, computed tomography (CT)‐guided drain placement is performed by an interventional radiologist (IVR) or surgeon because the difficulty of chest tube insertion is high in such cases. 2 …”