Article

Thoracoscopic management of empyema thoracis

Department of Cardiovascular and Thoracic Surgery, University of Texas, Southwestern Medical Center, Dallas, Texas, USA.
Journal of Minimal Access Surgery (Impact Factor: 1.37). 10/2007; 3(4):141-8. DOI: 10.4103/0972-9941.38908
Source: PubMed

ABSTRACT Appropriate management of empyema thoracis is dependent upon a secure diagnosis of the etiology of empyema and the phase of development. Minimal access surgery using video-assisted thoracoscopy (VATS) is one of many useful techniques in treating empyema. Complex empyema requires adjunctive treatment in addition to VATS.

Download full-text

Full-text

Available from: Daniel L Beckles, Jul 06, 2015
0 Followers
 · 
118 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To determine whether presumptive antibiotics reduce the risk of empyema or pneumonia following tube thoracostomy for traumatic hemopneumothorax. Methods: A prospective, randomized, double-blind trial was performed comparing the use of cefazolin for duration of tube thoracostomy placement (Group A) versus 24 hours (Group B) versus placebo (Group C). Results: A total of 224 patients received 229 tube thoracostomies. Logistic regression analysis revealed that duration of tube placement and thoracic acute injury score were predictive of empyema (p < 0.05). Empyema tended to occur more frequently in patients with penetrating injuries (p = 0.09). χ2 analysis showed pneumonia occurred significantly more frequently in blunt than penetrating injuries (p < 0.05). Presumptive antibiotic use did not significantly effect the incidence of empyema or pneumonia, although no empyemas occurred in Group A. Conclusions: The incidence of empyema was low and the use of presumptive antibiotics did not appear to reduce the risk of empyema or pneumonia.
    Journal of Trauma and Acute Care Surgery 09/2004; 57(4):742-749. · 1.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine whether presumptive antibiotics reduce the risk of empyema or pneumonia following tube thoracostomy for traumatic hemopneumothorax. A prospective, randomized, double-blind trial was performed comparing the use of cefazolin for duration of tube thoracostomy placement (Group A) versus 24 hours (Group B) versus placebo (Group C). A total of 224 patients received 229 tube thoracostomies. Logistic regression analysis revealed that duration of tube placement and thoracic acute injury score were predictive of empyema (p <0.05). Empyema tended to occur more frequently in patients with penetrating injuries (p=0.09). chi analysis showed pneumonia occurred significantly more frequently in blunt than penetrating injuries (p <0.05). Presumptive antibiotic use did not significantly effect the incidence of empyema or pneumonia, although no empyemas occurred in Group A. The incidence of empyema was low and the use of presumptive antibiotics did not appear to reduce the risk of empyema or pneumonia.
    The Journal of trauma 11/2004; 57(4):742-8; discussion 748-9. · 2.96 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients with pleural infections have a high risk of morbidity and mortality with prolonged hospitalization. The best methods for treating pleural infections remain debatable. Although the increasing drainage volume effect of streptokinase adjunctive to chest-tube, is well known, its effect on clinical outcomes like duration of hospitalization and need for further surgery, remains controversial. The aim of this study was to analyze the etiological and microbiological factors for pleural infections, and assess the effect of streptokinase adjunctive to chest tube for clinical outcomes. Charts of patients with a chest disease department discharge diagnosis of complicated parapneumonic effusion or empyema were retrospectively reviewed. Of the 107 patients (85 male), the mean age was 47.9+/-17.1 years. The most frequently shown bacteriological agent was Staphylococcus aureus. Drainage with thoracentesis was used in 44 patients (group 1); chest tube was performed in 44 patients (group 2) and intrapleural streptokinase was given after chest tube insertion in 19 patients (group 3). Mean hospitalization time in group 1 was shorter than the other two groups (P<0.05), but there was no significant difference between group 2 and 3. Our mortality rate was 8.4%. Success rates were 95.4%, 65.9% and 78.5% in groups 1, 2, and 3, respectively (P>0.05). Intrapleural streptokinase is a safe procedure but it did not effect the duration of hospitalization, mortality and success rate. Mortality remains especially high in patients with concomitant disease.
    Respiratory Medicine 02/2006; 100(2):286-91. DOI:10.1016/j.rmed.2005.05.018 · 2.92 Impact Factor