Minimally invasive treatment of thoracic empyema.
BACKGROUND
The present study was undertaken to assess the efficacy of serial thoracocentesis and saline irrigation for the treatment of pleural empyema, for post-pneumonia versus other causes.


METHODS
Included were 42 consecutive patients with complicated pleural effusion (n=14) or frank pus (n=28) at diagnostic thoracocentesis, of mean age 57.5 +/- 23.7 years. Pneumonia was the probable cause in 29 patients, other causes (principally thoracic surgery) in 13. In addition to antibiotics in all patients, ultrasonography-guided serial suction thoracocentesis with saline irrigation was used as therapy of first choice in most patients: 28/29 post-pneumonia and 9/13 non-pneumonic empyema. Exceptions were mainly on the grounds of preceding thoracic surgery.


RESULTS
Success rate was 86% in the post-pneumonia group, with no crossovers to more invasive therapy. Mortality was 14%, none empyema-related. Treatment was less successful in the non-pneumonia group at 69%, with a 56% crossover rate from thoracocentesis due to therapy failure. Mortality was 23 %.


CONCLUSIONS
Results indicate that timely, minimally invasive therapy is a feasible modality for the management of post-pneumonia thoracic empyema. Serial thoracocentesis was less suitable for the treatment of non-pneumonic empyema, however, particularly if it was a surgical complication. More invasive strategies seem preferable in such cases.
Simmers
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Department of Pulmonology, St. Lucas Andreas Hospital, Amsterdam, The Netherlands.
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D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D016724:Empyema, Pleural / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000401:mortality; D019152:Paracentesis / Q000009:adverse effects; D010996:Pleural Effusion / Q000150:complications; D018410:Pneumonia, Bacterial / Q000150:complications; D015996:Survival Rate; D019616:Thoracic Surgical Procedures / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome