title: Vacuum-assisted closure device: a useful tool in the management of severe intrathoracic infections.
abstract: BACKGROUND
  This study is an evaluation of the vacuum-assisted closure (VAC) therapy for the treatment of severe intrathoracic infections complicating lung resection, esophageal surgery, viscera perforation, or necrotizing pleuropulmonary infections.
  
  
  METHODS
  We reviewed the medical records of all patients treated by intrathoracic VAC therapy between January 2005 and December 2008. All patients underwent surgical debridement-decortication and control of the underlying cause of infection such as treatment of bronchus stump insufficiency, resection of necrotic lung, or closure of esophageal or intestinal leaks. Surgery was followed by intrathoracic VAC therapy until the infection was controlled. The VAC dressings were changed under general anesthesia and the chest wall was temporarily closed after each dressing change. All patients received systemic antibiotic therapy.
  
  
  RESULTS
  Twenty-seven patients (15 male, median age 64 years) underwent intrathoracic VAC dressings for the management of postresectional empyema (n=8) with and without bronchopleural fistula, necrotizing infections (n=7), and intrathoracic gastrointestinal leaks (n=12). The median length of VAC therapy was 22 days (range 5 to 66) and the median number of VAC changes per patient was 6 (range 2 to 16). In-hospital mortality was 19% (n=5) and was not related to VAC therapy or intrathoracic infection. Control of intrathoracic infection and closure of the chest cavity was achieved in all surviving patients.
  
  
  CONCLUSIONS
  Vacuum-assisted closure therapy is an efficient and safe adjunct to treat severe intrathoracic infections and may be a good alternative to the open window thoracostomy in selected patients. Long time intervals in between VAC changes and short course of therapy result in good patient acceptance.
authors.affiliation: Division of Thoracic and Vascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Alend
authors.initials: A
authors.lastname: Saadi
authors.forename: Jean Yannis
authors.initials: JY
authors.lastname: Perentes
authors.forename: Michel
authors.initials: M
authors.lastname: Gonzalez
authors.forename: Adrien Caliera
authors.initials: AC
authors.lastname: Tempia
authors.forename: Yabo
authors.initials: Y
authors.lastname: Wang
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Hans-Beat
authors.initials: HB
authors.lastname: Ris
authors.forename: Thorsten
authors.initials: T
authors.lastname: Krueger
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000628:therapy; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D013896:Thoracic Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D013907:Thoracostomy / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
chemical_list: D000900:Anti-Bacterial Agents