Chest
Clinical InvestigationsChest TubesPredicting Factors for Outcome of Tube Thoracostomy in Complicated Parapneumonic Effusion or Empyema
Section snippets
Patient Characteristics
We retrospectively analyzed the medical records of 121 patients with empyema or CPE treated from January 1993 to July 1997 at National Cheng Kung University Hospital, a tertiary referred medical center in southern Taiwan. Empyema was defined as pleural effusion that met one or more of the following criteria: (1) grossly purulent fluid; (2) positive effusion culture; and (3) positive Gram's stain for bacteria. CPEs were defined as parapneumonic effusion with one or more of the following criteria6
Patients Characteristics
One hundred twenty-one patients were included in the present study. The mean ± SD age of the study population was 59 ± 15 years. Male gender was more frequent (99 men vs 22 women). Among the 121 patients, the most common causes of empyema or CPE were pneumonia (65%) and lung abscess (16%) (Table 1). The most frequent clinical symptoms were fever (76%), chest pain (65%), cough (55%), and dyspnea (44%). The most frequent underlying conditions were diabetes mellitus (29%), malignancy (12%),
Discussion
The success rate for conventional tube thoracostomy drainage is 32 to 71%.4 Mandal and Thadepalli8 reported a 93% cure rate for patients treated by chest tube drainage alone. Their study was limited to patients with bacterial empyemas and excluded effusions caused by trauma, surgical intervention, esophageal diseases, or malignant diseases. The overall success rate of 53% in our study is comparable to that reported from other studies.9,10,11Substantial mortality rates from empyema have been
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Role of Chest Computed Tomography in Patients Hospitalized with Community-Acquired Complicated Parapneumonic Effusion or Empyema
2022, American Journal of the Medical SciencesAlteplase and DNase for the treatment of pleural empyema in rats
2019, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :It is a progressive disease whose evolution proceeds through three different stages: exudative, fibrinopurulent and organizational (lung entrapment) [1,2]. In the exudative phase, chest tube drainage (CTD) alone may be sufficient [3,4]. In the organizational phase, decortication may be required [5,6].
Current State of Empyema Management
2018, Annals of Thoracic SurgeryCitation Excerpt :These features of the HCUP NY SID allowed for a unique analysis of empyema management. Our data show persistent high rates of initial chest tube use, although prior studies demonstrated high failure rates of this treatment modality [3, 4], and most of the patients in our study ultimately required definitive operative intervention. More than half of the patients initially treated with a chest tube required multiple procedures during the index hospitalization, and 9% required reintervention within 90 days.
The American Association for Thoracic Surgery consensus guidelines for the management of empyema
2017, Journal of Thoracic and Cardiovascular SurgeryComparing posteroanterior with lateral and anteroposterior chest radiography in the initial detection of parapneumonic effusions
2016, American Journal of Emergency MedicinePleural infection: Past, present, and future directions
2015, The Lancet Respiratory MedicineCitation Excerpt :In view of the increasingly widespread use of bedside thoracic ultrasound by respiratory clinicians, particular interest in sonographic surrogates of poor response to medical therapy in pleural infection exists.42,43 Two studies40,41 have directly addressed such surrogates and have suggested that the presence of septations is predictive of poor outcome in pleural infection. This probably supports the suggestion that the septations in pro-fibrotic infected pleural collections lead to difficulty in percutaneous tube drainage, and therefore ineffectiveness of medical therapy.