Chest
Rigid Thorascopic Debridement and Continuous Pleural Irrigation in the Management of Empyema
Section snippets
Statistical Analysis
Results are expressed as mean±SEM.
Patient Population
From October 17, 1995 to April 30, 1996, 13 consecutive patients (11 men and two women) (average age, 33.4±5 years) with empyema underwent thorascopic debridement. Data concerning their respective perioperative courses were collected prospectively. One patient had evidence of bilateral empyemas. Nine patients were being treated for concomitant pneumonia. Patients were admitted to the hospital for the following reasons: penetrating chest trauma (six);
Results
The operative time averaged 49.6±4.6 min. Estimated blood loss was <150 mL in all cases and no patients required blood transfusions. Apart from the original chest tube site, a single additional port was utilized in eight procedures, while in six cases two additional ports were required. Our group always uses an additional port, if only to place a new chest tube through a noncontaminated tract. Predominant organisms that were identified by operative cultures included the following;
Discussion
Empyema encompasses a spectrum of pleural infection, ranging from an early exudative stage associated with thin, easily drained fluid, through a fibropurulent stage characterized by a thickening of the exudate and denser fibrin deposition, and finally the organizing stage in which a thick fibrous “peel” encases some or all of the lung.2, 5, 9 The principles of therapy include treating the underlying cause, appropriate antibiotics, and ensuring complete pleural drainage with lung expansion to
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