The clinical course and management of thoracic empyema

Abstract

We report a prospective multi-centre study of the clinical course and hospital management of thoracic empyema in 119 patients (mean age 54.8). The commonest presenting symptom was malaise (75%), 55% were febrile; 31% were previously well with no predisposing condition. Initial treatments were antibiotics alone (5), needle aspirations (46), intercostal tube drainage (61), rib resection (3) and decortication (4). Overall, intercostal drainage was used in 77 patients (16 failed aspirations), surgical rib resection in 24 (1 failed aspirations, 20 failed drainage), and surgical decortication in 28 (6 failed aspirations, 17 failed drainage). Only 4 patients received intrapleural fibrinolytic agents. Aspiration and drainage were likely to fail if the empyema was > 40% of the hemithorax. Median time from treatment start to discharge was: aspirations, 26 days; drainage, 23 days; resection 11 days; decortication, 12 days. Overall 21 patients died (12 with empyema as the major cause); two had been surgically treated. Mortality correlated with age, diabetes, heart failure, and low serum albumin at admission. Infecting organisms, identified in 109 patients (92%) included anaerobes (37), Str. melleri (36), and Str. pneumoniae (28). Six months after discharge, all but six survivors had regained their previous health.

Benefits of using omental pedicle flap over muscle flap for closure of open window thoracotomy

“…Thoracic empyema, which usually occurs after lung resection and pneumonia, remains a life-threatening infection, with a persistently high mortality rate ranging from 6% to 24% (1)(2)(3)(4). Adequate drainage is the first step to improve this infectious condition.…”

Outcome and mortality analysis in complicated parapneumonic effusion and empyema

“…Mortality and morbidity is high; 20% of patients with empyema die and approximately 20% require surgery to recover within 12 months of their infection. 1,2 Despite the advent of effective antibiotics, bacterial pneumonia still results in significant morbidity and mortality in the population. In one study of 1,424 patients hospitalized with community-acquired pneumonia, patients with pleural effusions were 2.7 times more likely to be treatment failures than were those without pleural effusions.…”

“…6 According to the American Thoracic Society, the ET process can be divided into three phases: (1) exudative (acute or Stage I), where exudative fluid accumulates without loculation; (2) fibrinopurulent (Stage II), where pleural fluid becomes turbid or purulent with loculation; and (3) organizing (chronic or Stage III), where thickened pus or fibrin peels begin to form, and granulation tissue replacement of the pleural space occurs. 1,2 The most common form of ET both in adults and children is attributable to parapneumonic effusion followed by complications of thoracic surgical procedures, such as esophageal surgery, cardiovascular surgery, and pulmonary surgery.…”

A 3- Year Review of Patients with Chronic Empyema Treated Surgically at Tikur Anbessa Specialized Referral Hospital, Addis Ababa, Ethiopia

“…As technology and medical science develops, in the last decades the video-assisted thoracic surgery (VATS) [8][9] has been demonstrated as an effective procedure in selected patients, allowing an optimal debridement of early organized pleural effusions. In the late phase of the pleural infectious process, when a thick pleural peel encases the lung, a pulmonary decortication is required and open approach is often needed [10][11] .…”