Original ArticlesOutcome of primary empyema thoracis: therapeutic and microbiologic aspects
Section snippets
Patients and methods
This prospective, longitudinal, nonblinded study involves 179 consecutive adult patients seen with a diagnosis of primary bacterial thoracic empyema from July 1973 to July 1997. There were 141 men and 38 women aged 19 to 82 years (mean age, 40 ± 1 years [± standard error of the mean]). There were 131 black patients (73%), 43 Latino patients (24%), and 5 patients of other races (3%). From 1987 when the test for human immunodeficiency virus infection became widely used, 81 consecutive patients
Surgical outcomes
As summarized in Figure 1, 179 patients underwent 214 therapeutic procedures. Of the 20 patients who had thoracentesis, 18 (90%) were cured, and 2 (10%) subsequently required decortication as a secondary procedure. Nine patients were treated by image-guided catheter drainage with a success rate of 89% (8 of 9). The patient in whom this method failed required secondary decortication.
As shown in Figure 1, most of the patients (n = 90) were treated initially with closed thoracostomy. Fifty-six
Comment
The suppurative process in the pleural space can be diffuse or localized. The pathologic stages are exudative, fibrinopurulent, and organizing and correlate well with the clinical phases—acute, transitional, and chronic. Thus, the choice of drainage procedure should be based on the pathologic and clinical phases of the suppurative processes 6, 7, not on the biochemical variables. During the acute (exudative) phase, thin fluid can be aspirated, and this may be adequate as both a diagnostic and a
Acknowledgements
We thank Ms Charvette Pilchier for her patience and for processing the manuscript, and Ms Mina R. Mandal for her assistance in our literature search.
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2021, Annals of Thoracic SurgerySurgical and nonsurgical outcomes for treating a cohort of empyema thoracis patients: A monocenteric retrospective cohort study
2017, Annals of Medicine and SurgeryCitation Excerpt :When the results of this study are compared to single treatment studies of the literature, there are various studies that are in favor of the results achieved in the current study. It has been reported that 39%–58% of patients with primary empyema required open thoracotomy decortication with low morbidity and mortality rates [19,22,27]. Eight randomized controlled trial studies of the literature (one study comparing only open thoracotomy vs. thoracostomy tube drainage and seven studies comparing VATS vs. thoracostomy tube drainage) have been reviewed, meta-analyzed, and reported with conflicting results; however, neither a universally acceptable primary modality nor a gold standard of their protocol is available [28].
Video-assisted thoracoscopic surgical decortication in the elderly with thoracic empyema: Five years' experience
2016, Journal of the Chinese Medical AssociationCitation Excerpt :In our study, the mean hospital stay was longer (27.5 days) than previous reports,5,12 as the patients were older in our study (73.6 years vs. 55 years). However, the 30-day mortality was only 3% in our study, which was similar with previous studies.19 Eleven cases (33%) were diagnosed with coexisting lung abscess in our study.
Post-traumatic empyema: Aetiology, surgery and outcome in 125 consecutive patients
2013, InjuryCitation Excerpt :Our present series is consistent with these findings, in that all our patients sustained thoracic trauma and 95% had chest tubes prior to the diagnosis of empyema. It has been suggested that the bacteriology of post-traumatic empyema differs from post-infectious etiologies, with Streptococcus pneumonia and staphylococci predominating in the latter.16 In our present study, while staphylococci were the leading organisms, anaerobes and Gram positive rods were also frequently isolated (Table 2).