Open window thoracostomy in the management of postpneumonectomy empyema with or without bronchopleural fistula

Shamji, Farid M.; Ginsberg, Robert J.; Cooper, Joel D.; Spratt, Ernest H.; Goldberg, Melvyn; Waters, Paul F.; Ilves, Riivo; Todd, T.R.; Pearson, F.G.

doi:10.1016/s0022-5223(19)39057-9

Cited by 80 publications

(18 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, one would also predict that open-window thoracostomy would lead to opposite alterations in patients with chronic empyema. Indeed, this procedure involves resecting two to five adjacent ribs and the intercostal soft tissues so as to expose widely the empyema cavity, aspirate the pus and necrotic debris, and then fill the cavity with gauze and antibiotic solution (4,5,20,23). In the last 4 yr, four patients with postpneumonectomy empyema have been treated by extensive open-window thoracostomy (3-4 ribs) at our institution.…”

Section: Discussionmentioning

confidence: 99%

Role of rib cage elastance in the coupling between the abdominal muscles and the lung

Cappello

Troyer²

2004

Journal of Applied Physiology

View full text Add to dashboard Cite

The abdominal muscles expand the rib cage when they contract alone. This expansion opposes the deflation of the lung and may be viewed as pressure dissipation. The hypothesis was raised, therefore, that alterations in rib cage elastance should affect the lung deflating action of these muscles. To test this hypothesis and evaluate the quantitative importance of this effect, we measured the changes in airway opening pressure (Pao), abdominal pressure (Pab), and rib cage transverse diameter during isolated stimulation of the transversus abdominis muscle in anesthetized dogs, first with the rib cage intact and then after rib cage elastance was increased by clamping the ribs and the sternum. Stimulation produced increases in Pao, Pab, and rib cage diameter in both conditions. With the ribs and sternum clamped, however, the change in Pab was unchanged but the change in Pao was increased by 77% (P < 0.001). In a second experiment, the transversus abdominis was stimulated before and after rib cage elastance was reduced by removing the bony ribs 3-8. Although the change in Pab after removal of the the ribs was still unchanged, the change in Pao was reduced by 62% (P < 0.001). These observations, supported by a model analysis, indicate that rib cage elastance is a major determinant of the mechanical coupling between the abdominal muscles and the lung. In fact, in the dog, the effects of rib cage elastance and Pab on the lung-deflating action of the abdominal muscles are of the same order of magnitude.

show abstract

Section: Discussionmentioning

confidence: 99%

Role of rib cage elastance in the coupling between the abdominal muscles and the lung

Cappello

Troyer²

2004

Journal of Applied Physiology

View full text Add to dashboard Cite

show abstract

“…22,23,24 Open window thoracostomy is an ideal method for draining the septic pleural cavity in patients with empyema after pulmonary resection, especially in patients with postpneumonectomy bronchopleural fistula. 11,12,13,25 Phrenic nerve block is used as temporary reduction of pleural cavity by raising the dome of diaphragm, which is contraindicated in patients with limited lung function. 26 Clagett procedure is a two-stage procedure, which begins with open pleural damage and re-suturing of bronchial stump followed by packing of space with once or twice a day dressing with quarter strength Dakin's solution or povidoneiodine solution 20: 1.…”

Section: Discussionmentioning

confidence: 99%

“…Early bronchopleural fistula requires urgent intervention with principle of surgical bronchopleural fistula repair, that is maintenance of vascularity as well as keep the short bronchial stump once the pleural cavity is clean. 12,25,26,31,32 Late bronchopleural fistula requires either Clagett procedure or trans-sternal transpericardial approach. As Clagett procedure is multistep, prolonged and associated with high morbidity, the trans-sternal transpericardial approach which was initially described by Abruzzini is an option to avoid entering in a previously manipulated and diseased inflammatory cavity.…”

Section: Discussionmentioning

confidence: 99%

“…Open window thoracostomy is associated with psychosocial stigma, especially in young age group patients due to a large opening present in thoracic wall which needs daily dressing. [11][12][13][14] To address the negative psychosocial impact and poor quality of life in these chronic empyema thoracis patients treated with open window thoracostomy, extensive literature search was done by author to find evidence based alternative surgical method.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Dead Space Reduction Closed Thoracoplasty in Chronic Empyema Thoracis Patients of Early Young Age Group

Sharma¹,

Gupta²,

Kaushal³

et al. 2018

jemds

View full text Add to dashboard Cite

BACKGROUNDThe social stigma of chronic empyema thoracis treated with open window thoracostomy (OWT) has significant negative impact on psychosocial well-being, especially in early young age group patients. So, evaluation of better alternative of dead space reduction closed thoracoplasty method was done by the author. Aims and Objectives-To evaluate standard easily reproducible surgical method to cure and control chronic empyema thoracis other than open window thoracostomy in early young age group patients in central India. MATERIALS AND METHODSDead space reduction closed thoracoplasty was performed in 44 patients of chronic empyema thoracis between the age group of 13 and 25 years by conventional thoracoplasty (Alexander type), tailoring thoracoplasty and Schede thoracoplasty. Patients were evaluated in terms of weight gain, chest x-ray, air leak and column movement in ICD and pus culture sensitivity at regular intervals. Targeted dead space reduction is achieved excellently when column movement is less than 5 cm and acceptable when between 5 and 10 cm. Absence of air leak even on coughing (excellent) and only on coughing (acceptable) in patent intercostal drainage tube. Statistical Analysis-By student's t-test, repeated measure ANOVA test for difference of mean, confidence interval with standard error estimation, 'p' value and percentage also. Setting and Design-A hospital-based prospective longitudinal study as all the enrolled patients are followed up at designed time. RESULTSChronic empyema thoracis of 40 patients was cured and controlled with dead space reduction thoracoplasty, whereas 4 patients with multi-drug resistance tuberculosis (MDR TB) did not cure, so they further required other modalities. CONCLUSIONPatients with persistent infection and poor weight gain have high failure rate in dead space reduction closed thoracoplasty.

show abstract

“…Omental flap and mediastinal fat pad have also been used with great success for bronchial stump buttressing 24,25 . The reported success rates of modified Clagett technique for PPE with BPF are as high as 80−100% in the modern clinical setting (Table 3) 24−27 .…”

Section: Managementmentioning

confidence: 99%

Post‐pneumonectomy empyema: Current management strategies

Wan

Lee

et al. 2005

ANZ Journal of Surgery

View full text Add to dashboard Cite

Post-pneumonectomy empyema is an uncommon but potentially life-threatening complication. It has a strong association with bronchopleural fistula, which acts as a continued source of infection into the thoracic cavity. Numerous risk factors have been identified and strategies formulated to minimize its occurrence. When bronchopleural fistula occurs, its treatment depends on several factors including extent of dehiscence, degree of pleural contamination and general condition of the patient. Early diagnosis and assessment with appropriate investigations, and aggressive therapeutic strategies are paramount in controlling sepsis, facilitating closure of fistula, and sterilization of the closed pleural space. Recent success with repeat debridement has made routine space obliteration not mandatory in management. The development of minimal-access interventions including video-assisted thoracic surgery, endoscopic application of tissue glue and stenting may be additional tools to complement conventional surgery in post-pneumonectomy empyema management.

show abstract

Open window thoracostomy in the management of postpneumonectomy empyema with or without bronchopleural fistula

Cited by 80 publications

References 6 publications

Role of rib cage elastance in the coupling between the abdominal muscles and the lung

Role of rib cage elastance in the coupling between the abdominal muscles and the lung

Dead Space Reduction Closed Thoracoplasty in Chronic Empyema Thoracis Patients of Early Young Age Group

Post‐pneumonectomy empyema: Current management strategies

Contact Info

Product

Resources

About