Is Medical Thoracoscopy Efficient in the Management of Multiloculated and Organized Thoracic Empyema?
Department of Disease of the Thorax, Pulmonology Unit, Morgagni Hospital, Forlì, Italy. Respiration
(Impact Factor: 2.59).
07/2012; 84(3):219-24. DOI: 10.1159/000339414
Background: Pleural empyema can be subdivided into 3 stages: exudative, multiloculated, and organizing. In the absence of clear septation, antibiotics plus simple drainage of pleural fluid is often sufficient treatment, whereas clear septation often requires more invasive treatment. Objectives: The aim of this study was to report our experience and analyze the safety and efficacy of medical thoracoscopy in patients with multiloculated and organizing empyema. Methods: We performed a retrospective study reviewing the files of patients referred for empyema and treated by medical thoracoscopy at our department from July 2005 to February 2011. Results: A total of 41 patients with empyema were treated by medical thoracoscopy; empyema was free flowing in 9 patients (22%), multiloculated in 24 patients (58.5%), and organized in 8 patients (19.5%). Medical thoracoscopy was considered successful without further intervention in 35 of 41 patients (85.4%): all of the 9 patients with free-flowing fluid, 22 of the 24 patients with multiloculated empyema (91.7%), and only 4 of the 8 patients with organizing effusion (50%). Conclusions: Our study confirms that multiloculated pleural empyema could safely and successfully be treated with medical thoracoscopy while organizing empyema can be resistant to drainage with medical thoracoscopy, requiring video-assisted thoracic surgery or open surgical decortications; among this population, the presence of separate 'pockets' not in apparent communication with each other often leads to a surgical approach.
Figures in this publication
Available from: Yong Soo Kwon
- "The usefulness of this procedure in pleural infection has not been well evaluated. Several retrospective studies reported high success rates with low complication rates in multiloculated empyema16,17. However, since there was no randomized study for the utility and safety of this procedure in pleural infection, further prospective comparative studies are needed. "
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ABSTRACT: Increasing incidence of pleural infection has been reported worldwide in recent decades. The pathogens responsible for pleural infection are changing and differ from those in community acquired pneumonia. The main treatments for pleural infection are antibiotics and drainage of infected pleural fluid. The efficacy of intrapleural fibrinolytics remains unclear, although a recent randomized control study showed that the novel combination of tissue plasminogen activator and deoxyribonuclease had improved clinical outcomes. Surgical drainage is a critical treatment in patient with progression of sepsis and failure in tube drainage.
Tuberculosis and Respiratory Diseases 04/2014; 76(4):160-162. DOI:10.4046/trd.2014.76.4.160
Available from: Andrew R Medford
Respiration 11/2012; 85(1). DOI:10.1159/000343620 · 2.59 Impact Factor
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ABSTRACT: Purpose of review:
Pleural infection is a common and serious clinical problem that because of its high morbidity and mortality imposes a significant burden on clinicians, healthcare resources and patients of all ages. Defining the optimal management strategy for pleural infection remains a cause for research and debate. This review considers the areas of interest including bacteriology and antibiotic selection, intrapleural fibrinolytics and the role of surgery.
Pleural infection is increasing in the adult and paediatric populations without clear explanation and with clinical and financial consequences. The bacteriology of pleural infection is recognized as being unique from parenchymal lung infection with implications for its treatment. Although established in paediatric management, intrapleural fibrinolytics remain of uncertain benefit in adults, though the novel combination of tissue plasminogen activator and deoxyribonuclease used in the MIST2 study offers cause for optimism. Surgery remains a key intervention in pleural infection, but its precise role is unclear with no robust evidence to show when and in whom it should be optimally utilized.
The high mortality in adults from pleural infection despite advances in clinical knowledge, diagnostics and therapeutics highlights the need for ongoing research. Future studies are required to focus on improving the clinical outcomes, with the identification of those patients at greatest risk of poor outcomes at presentation and most likely to benefit from more radical treatment a priority to allow the delivery of individualized care.
Current Opinion in Infectious Diseases 01/2013; 26(2). DOI:10.1097/QCO.0b013e32835d0b71 · 5.01 Impact Factor
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