Thoracoscopic debridement and pleural irrigation in the management of empyema thoracis

Ridley, Paul; Braimbridge, M. V.

doi:10.1016/0003-4975(91)90866-o

Cited by 129 publications

(45 citation statements)

References 9 publications

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“…For years, thoracoscopy has largely been used in pleural effusion due to lung infection, as an alternative to thoracotomy [12,28,29], because it allows the mechanical removal of infected material and permits lung re-expansion [9,[30][31][32]. It is possible to open multiple loculations and aspirate the purulent liquid, removing the fibrinous adhesions, including the layer on visceral pleura.…”

Section: Thoracoscopymentioning

confidence: 99%

Advanced techniques in medical thoracoscopy

Tassi¹,

Davies²,

Noppen³

2006

Eur Respir J

103

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For expert pulmonologists, advanced procedures in medical thoracoscopy are the nonroutine and more complex applications of the method. The main current indications are the treatment of infected pleural space, forceps lung biopsy and sympathectomy.In parapneumonic effusions and empyema, medical thoracoscopy is as a drainage procedure, intermediate between tube thoracostomy and video-assisted thoracoscopic surgery (VATS), which is efficient, significantly lower in cost and avoids surgical thoracoscopy under general anaesthesia. It is essential that it is performed early in the course of the disease and is particularly advisable for frail patients at high surgical risk.The efficacy of forceps lung biopsy has been demonstrated in diffuse lung diseases, whereas results in localised lung diseases and chest-wall lesions have been less positive. However, VATS is currently the preferred approach for these indications. The technique still maintains its efficacy for visceral pleura and peripheral lung biopsy, in particular in the presence of pleural effusion and lung disorders.At the present time, thoracoscopic sympathectomy is minimally invasive and is an accepted intervention for patients with a variety of autonomous nervous system disturbances. Essential hyperhidrosis patients, and well-selected patients with other disorders, can be helped with this procedure, which can also be performed by interventional pulmonologists.

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Section: Thoracoscopymentioning

confidence: 99%

Advanced techniques in medical thoracoscopy

Tassi¹,

Davies²,

Noppen³

2006

Eur Respir J

103

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“…In cases with multiple loculations, it is possible to open these spaces, to remove the fibrinopurulent membranes by forceps and to create one single cavity, which can be drained and irrigated much more successfully [5,78,79]. This treatment should be carried out early in the course of empyema, before the adhesions become too fibrous and adherent.…”

Section: Empyemamentioning

confidence: 99%

Thoracoscopy--state of the art

1998

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Number 12 in this SeriesThoracoscopy -state of the art R. Loddenkemper aa Thoracoscopy was introduced by JACOBAEUS [1], an internist in Stockholm in 1910, primarily as a diagnostic procedure in two cases of exudative (tuberculous) pleuritis. In his excellent overview "Thoracoscopy and its practical importance" JACOBAEUS [1] published his accumulated experience of thoracoscopy in all the indications which are still in 1998 the domain of pneumologists [2]. With malignant effusion, he was frequently able to differentiate between primary and secondary tumours of the chest wall, pleura, lung and mediastinum. He divided tuberculous pleurisy into different stages, studied rheumatic and nonspecific parapneumonic effusions and he performed thoracoscopy in more than 100 empyemas, many of which were nontuberculous. He also appreciated that, frequently, one could not visualize the defect in idiopathic, spontaneous pneumothorax. However, during the ensuing 40 yrs, thoracoscopy was applied on a worldwide scale almost exclusively for the lysis of pleural adhesions by means of thoracocautery ("Jacobaeus' Operation") to facilitate pneumothorax treatment of tuberculosis (TB) [3].With the advent of antibiotic therapy for TB, a generation of physicians, already familiar with the therapeutic application of thoracoscopy, began, mainly in Europe, to use this technique on a wider basis for evaluating many pleuropulmonary diseases [4,5]. Detailed descriptions of pleural disease, with emphasis on tuberculous and malignant effusions, appeared in the literature and the diagnostic potential was again verified. Concurrently, many American surgeons preferred thoracotomy and open biopsy for evaluation of these diseases.Due to technical improvements and a trend towards less invasive procedures, thoracoscopy was rediscovered by thoracic surgeons at the beginning of this decade, and termed "surgical" thoracoscopy, which is more precisely known as video-assisted thoracic surgery (VATS) [6][7][8]. Interestingly, this revival has also supported the introduction of "medical" thoracoscopy into the scope of respiratory physicians, in particular in the USA where, according to a national survey in 1994, already more than 5% of all pulmonologists were applying medical thoracoscopy [9]. In Thoracoscopy -state of the art. R. Loddenkemper. ERS Journals Ltd 1998. ABSTRACT: "Medical" thoracoscopy as compared with "surgical" thoracoscopy (which is more precisely known as video-assisted thoracic surgery (VATS)) has the advantage that it can be performed under local anaesthesia or conscious sedation, in an endoscopy suite, using nondisposible rigid instruments. Thus, it is considerably less invasive and less expensive.The main diagnostic and therapeutic indications for medical thoracoscopy are pleural effusions and pneumothorax. Due to its high diagnostic accuracy, approaching almost 100% in malignant and tuberculous pleural effusions, it should be used when pleural fluid analysis and needle biopsy are nondiagnostic. In addition, medical thoracoscopy provides st...

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“…These include needle aspiration, chest tube drainage, thoracoscopic drainage and open thoracotomy. Recent advances in this area include the use of smaller, flexible image-guided catheters [7], the administration of adjunctive intrapleural fibrinolytic agents to facilitate fluid drainage [8], and surgical interventions such as video-assisted thoracoscopic drainage (which is less painful than conventional thoracotomy) [9,10].…”

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confidence: 99%

Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis

Tk¹,

Chin²

1999

Eur Respir J

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Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis. T.K. Lim, N.K. Chin. #ERS Journals Ltd 1999. ABSTRACT: The efficacy of three different treatment protocols was compared: 1) simple chest tube drainage (Drain); 2) adjunctive intrapleural streptokinase (IP-SK); and 3) an aggressive empirical approach incorporating SK and early surgical drainage (SK+early OP) in patients with pleural empyema and high-risk parapneumonic effusions.This was a nonrandomized, prospective, controlled time series study of 82 consecutive patients with community-acquired empyema (n=68) and high-risk parapneumonic effusions (n=14). The following three treatment protocols were administered in sequence over 6 years: 1) Drain (n=29, chest catheter drainage); 2) IP-SK (n=23, adjunctive intrapleural fibrinolysis with 250,000 U . day -1 SK); and 3) SK+early OP (n=30, early surgical drainage was offered to patients who failed to respond promptly following initial drainage plus SK).The average duration of hospital stay in the SK+early OP group was significantly shorter than in the Drain and IP-SK groups. The mortality rate was also significantly lower in the SK+early OP than the Drain groups (3 versus 24%).It was concluded that an empirical treatment strategy which combines adjunctive intrapleural fibrinolysis with early surgical intervention results in shorter hospital stays and may reduce mortality in patients with pleural sepsis. Eur Respir J 1999; 13: 514±518.

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Thoracoscopic debridement and pleural irrigation in the management of empyema thoracis

Cited by 129 publications

References 9 publications

Advanced techniques in medical thoracoscopy

Advanced techniques in medical thoracoscopy

Thoracoscopy--state of the art

Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis

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