Thoracoscopic Debridement of Empyema Thoracis

Lawrence, David; Ohri, Sunil K.; Moxon, Ruth E.; Townsend, Edward R.; Fountain, S. W.

doi:10.1016/s0003-4975(97)00917-x

Cited by 98 publications

(66 citation statements)

References 10 publications

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“…Complications are strictly related to case complexity and are mainly represented by air leaks, which are sometimes prolonged, and by bleeding, with incidences of between 16 [42] and 0% [31,39]. In some surgical series comprising patients with heavy comorbidities, some deaths were described [38,40,42,[44][45][46].…”

Section: Results and Complicationsmentioning

confidence: 99%

“…When the presence of multiple loculations is observed in the effusion, multiloculated pleural effusion [34,37] and multiloculated empyema in a fibrinopurulent stage [28,34,38,39] are indicated, and thoracoscopy is appropriate. More recently, the indication for surgical treatment using VATS has been extended to chronic organising empyema, both for debridement before thoracotomic decortication [40] and for thoracoscopic decortication [41].…”

Section: Indicationsmentioning

confidence: 99%

See 1 more Smart Citation

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: Results and Complicationsmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Advanced techniques in medical thoracoscopy

Tassi¹,

Davies²,

Noppen³

2006

Eur Respir J

103

View full text Add to dashboard Cite

show abstract

“…Seven studies evaluating VATS in CPPE (with a total of 440 patients from the period 1996-2006) yielded an overall success rate of 86% [45][46][47][48][49][50][51]. This high success rate was primarily generated by the largest study (234 patients), which was by Luh et al [50], who reported a success rate of 88%.…”

Section: Managementmentioning

confidence: 99%

Diagnosis and Management of Parapneumonic Effusions and Empyema

2007

Clinical Infectious Diseases

176

144

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Approximately 1 million patients develop parapneumonic effusions (PPEs) annually in the United States. The outcome of these effusions is related to the interval between the onset of clinical symptoms and presentation to the physician, comorbidities, and timely management. Early antibiotic treatment usually prevents the development of a PPE and its progression to a complicated PPE and empyema. Pleural fluid analysis provides diagnostic information and guides therapy. If the PPE is small to moderate in size, free-flowing, and nonpurulent (pH, 17.30), it is highly likely that antibiotic treatment alone will be effective. Prolonged pneumonia symptoms before evaluation, pleural fluid with a pH !7.20, and loculated pleural fluid suggest the need for pleural space drainage. The presence of pus (empyema) aspirated from the pleural space always requires drainage. Fibrinolytics are most likely to be effective during the early fibrinolytic stage and may make surgical drainage unnecessary. If pleural space drainage is ineffective, video-assisted thoracic surgery should be performed without delay.Parapneumonic effusion (PPE; i.e., pleural fluid that results from pneumonia or lung abscess) is the most common cause of an exudative pleural effusion. PPE may be the consequence of either community-acquired or nosocomial pneumonia. Between 20% and 57% of the 1 million patients hospitalized yearly in the United States with pneumonia develop a PPE [1][2][3]. Although PPEs are relatively common, empyema (i.e., the accumulation of pus in the pleural space) is less common, occurring in 5%-10% of patients who experience PPE [4]. In a review of 14 studies of empyema that involved a total of 1383 patients, 70% of PPEs were secondary to pneumonia (figure 1) [4]. CLASSIFICATIONA practical, clinical classification of PPE is as follows: (1) an uncomplicated parapneumonic effusion (UPPE) resolves with antibiotic therapy alone, without pleural space sequelae; (2) a complicated parapneumonic effusion (CPPE) requires pleural space drainage to resolve pleural sepsis and prevent progression to an empyema; and (3) empyema, the end stage of a PPE, occurs. Empyema is defined by its appearance; it is an opaque, whitish-yellow, viscous fluid that is the result of serum coagulation proteins, cellular debris, and fibrin deposition. Empyemas develop primarily because of delayed presentation by the patient with advanced pneumonia and progressive pleural infection and, less often, from inappropriate clinical management. Early antibiotic treatment prevents progression of pneumonia and the development of a PPE. Early antibiotic treatment will prevent development of an UPPE and progression to empyema. Risk factors for empyema include age (empyemas occur most frequently among children and elderly persons), debilitation, male sex, pneumonia requiring hospitalization, and comorbid diseases, such as bronchiectasis, chronic obstructive pulmonary disease, rheumatoid arthritis, alcoholism, diabetes, and gastroesophageal reflux disease [5]. Bacterial pneumonia, pneumon...

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“…Lawrence DR in their study concluded that primary surgical therapy with VATS should be considered for all patients with pleural empyema irrespective off the duration of symptoms [7].…”

Section: Discussionmentioning

confidence: 99%