Chest
Volume 111, Issue 2, February 1997, Pages 272-274
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Rigid Thorascopic Debridement and Continuous Pleural Irrigation in the Management of Empyema

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Study objective

To determine the role of rigid thoracoscopy and continuous pleural irrigation as an alternative to thoracotomy in critically ill patients.

Design/setting/patients/interventions

Thirteen patients with empyema (one bilateral) underwent thorascopic decortication and continuous postoperative irrigation with normal saline solution. Seven patients required preoperative ventilator support.

Measurements and results

Double-lumen intubation was utilized in only two cases. Empyemas were drained effectively in all patients, including nine patients in whom dense adhesions were encountered. Mean duration of irrigation was 3.5±0.5 days. There were no deaths. One patient developed a recurrent empyema 1 week after resolution of symptoms and underwent thoracotomy.

Conclusions

Rigid thorascopic decortication is an effective method for treating empyemas and can be considered before thoracotomy. It can be performed in patients who might not be candidates for video-assisted thorascopic approaches owing to inability to tolerate one-lung anesthesia or who have dense adhesions preventing lung collapse.

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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