VATS and Intrapleural Fibrinolytic Therapy for Parapneumonic Empyema

Ohara, Gen; Iguchi, Kesato; Satoh, Hiroaki

doi:10.5761/atcs.lte.18-00092

Cited by 7 publications

(5 citation statements)

References 1 publication

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“…However, VATS may be not routinely available in many centers. Many series advocated that VATS application is the 1 st choice in the management of empyema, in which ICT remains insufficient, with a high success rate and considerably decrease the need for open drainage by thoracotomy [21,22].…”

Section: Discussionmentioning

confidence: 99%

Evolving Fibrinolytic Option in the Management of Second Stage of Empyema

Alawady

Elsharawy

Elfakharany

et al. 2022

Zagazig University Medical Journal

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Background: Intrapleural fibrinolytics installation is considered an alternative method to aggressive operative intervention. This conservative medical management may decrease morbidity and mortality that were recorded with surgery. Our study investigates the outcome of tissue plasminogen activator (TPA), alteplase, and streptokinase (SK) as a treatment for stage II of empyema. Methods: This study prospectively evaluated 38 patients that had stage II of empyema. The patients were divided into two groups with installing one fibrinolytic protocol into a chest tube for each group: group A, (TPA) and group B, (SK). The evaluation was based upon clinical examination and radiological findings for the efficacy of each protocol. Results: There were no differences in baseline characteristics between both groups. There was a significant improvement after 1 st , where 11 patients (52.4%) improved in the TPA group with only 3 patients (17.6%) in the SK group. TPA group showed 100% success, on the other hand, SK Group had 2 patients' failure (11.8%) and surgical intervention was necessary for them. Hemorrhagic complications were 9.5% and 17.6% for TPA and SK respectively. Finally, there was a significantly prolonged duration of mean hospital stay with SK therapy (5.48 vs 8.59 days). Conclusions: Both fibrinolytic protocols were effective and safe for empyema management, but Alteplase had a better outcome.

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Section: Discussionmentioning

confidence: 99%

Evolving Fibrinolytic Option in the Management of Second Stage of Empyema

Alawady

Elsharawy

Elfakharany

et al. 2022

Zagazig University Medical Journal

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“…Thoracic empyema is a condition where there is fluid in the pleural cavity in the form of pus, thick, and purulent (Ohara et al, 2018). Pleural effusion occurs because the balance between the production and expenditure of pleural fluid is disturbed (Kelly et al, 2018) The clinical course of parapneumonic effusion is divided into two major parts, namely based on infection by aerobic bacteria or anaerobic bacteria.…”

Section: Case Discussionmentioning

confidence: 99%

Shortterm Outcome Air Plombage Thoracoplasty of Empyema Thoracis at Pulmonary Tuberculosis

Chan¹,

Bergant²,

Aulia³

2022

KESANS

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Pulmonary tuberculosis (pulmonary TB) is a type of infectious disease caused by the bacterium Mycobacterium tuberculosis. A male patient aged 40 years, came to the hospital with complaints of shortness of breath, severe shortness of breath for 1 week before coming to the hospital, the patient had a history of having WSD installed, on palpation the left vocal fremitus was stronger than the right, percussion was found to be dim in the basal area. lung, hyperresonance in the medial-apex area pulmo dextra and sonor on pulmo sinistra, decreased vesicular auscultation in the right lung, chest X-ray found pleural effusion. The patient was treated with air surge therapy. After surgery and evaluated for 4 days in the hospital and repeated follow-up on patients where the results of the examination did not find recurrent effusions.

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“…Thus, the shift from a more invasive surgical approach for stage III empyema towards VATS becomes feasible. A trend towards less invasive procedures to treat stage II/III empyema in combination with the recently reported equal efficacy of VATS and IPFT ( Ohara et al, 2018 ; Samancilar et al, 2018 ; Kermenli and Azar, 2021 ) opens a window of opportunity to expand the use of pharmacological treatment in advanced stage empyema.…”

Section: Using Minimally Invasive Treatments For More Advanced-stage Empyema: a Novel Approachmentioning

confidence: 99%

From Bedside to the Bench—A Call for Novel Approaches to Prognostic Evaluation and Treatment of Empyema

et al. 2022

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Empyema, a severe complication of pneumonia, trauma, and surgery is characterized by fibrinopurulent effusions and loculations that can result in lung restriction and resistance to drainage. For decades, efforts have been focused on finding a universal treatment that could be applied to all patients with practice recommendations varying between intrapleural fibrinolytic therapy (IPFT) and surgical drainage. However, despite medical advances, the incidence of empyema has increased, suggesting a gap in our understanding of the pathophysiology of this disease and insufficient crosstalk between clinical practice and preclinical research, which slows the development of innovative, personalized therapies. The recent trend towards less invasive treatments in advanced stage empyema opens new opportunities for pharmacological interventions. Its remarkable efficacy in pediatric empyema makes IPFT the first line treatment. Unfortunately, treatment approaches used in pediatrics cannot be extrapolated to empyema in adults, where there is a high level of failure in IPFT when treating advanced stage disease. The risk of bleeding complications and lack of effective low dose IPFT for patients with contraindications to surgery (up to 30%) promote a debate regarding the choice of fibrinolysin, its dosage and schedule. These challenges, which together with a lack of point of care diagnostics to personalize treatment of empyema, contribute to high (up to 20%) mortality in empyema in adults and should be addressed preclinically using validated animal models. Modern preclinical studies are delivering innovative solutions for evaluation and treatment of empyema in clinical practice: low dose, targeted treatments, novel biomarkers to predict IPFT success or failure, novel delivery methods such as encapsulating fibrinolysin in echogenic liposomal carriers to increase the half-life of plasminogen activator. Translational research focused on understanding the pathophysiological mechanisms that control 1) the transition from acute to advanced-stage, chronic empyema, and 2) differences in outcomes of IPFT between pediatric and adult patients, will identify new molecular targets in empyema. We believe that seamless bidirectional communication between those working at the bedside and the bench would result in novel personalized approaches to improve pharmacological treatment outcomes, thus widening the window for use of IPFT in adult patients with advanced stage empyema.

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VATS and Intrapleural Fibrinolytic Therapy for Parapneumonic Empyema

Cited by 7 publications

References 1 publication

Evolving Fibrinolytic Option in the Management of Second Stage of Empyema

Evolving Fibrinolytic Option in the Management of Second Stage of Empyema

Shortterm Outcome Air Plombage Thoracoplasty of Empyema Thoracis at Pulmonary Tuberculosis

From Bedside to the Bench—A Call for Novel Approaches to Prognostic Evaluation and Treatment of Empyema

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