title: Management of chronic empyema with unexpandable lung in poor surgical risk patients using an empyema tube.
abstract: OBJECTIVE
  High preoperative risk precludes decortication and other surgical interventions in some patients with chronic empyema. We manage such patients by converting the chest tube into an "empyema tube," cutting the tube near the skin and securing the end with a sterile clip to allow for open pleural drainage. The patient is followed serially, and the tube gradually withdrawn based on radiological resolution and amount of drainage.
  
  
  METHODS
  Between 2010 and 2014, patients with chronic empyema and unexpandable lung, deemed high-risk surgical candidates, had staged chest tube removal, and were included for the study. The volume of fluid drained, culture results, duration of drainage, functional status, and comorbidities were recorded.
  
  
  RESULTS
  Eight patients qualified. All had resolution of infection. The tube was removed after an average of 73.6 ± 49.73 (95% confidence interval [CI]) days. The mean duration of antibiotic treatment was 5.37 ± 1.04 (95% CI) weeks. None required surgery or experienced complications from an empyema tube.
  
  
  CONCLUSIONS
  A strategy of empyema tube drainage with staged removal is an option in appropriately selected patients with chronic empyema, unexpandable lung, and poor surgical candidacy.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL 32610-0225, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Biswas
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL 32610-0225, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jantz
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL 32610-0225, USA.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Penley
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL 32610-0225, USA.
authors.forename: Hiren J
authors.initials: HJ
authors.lastname: Mehta
keywords: Chronic empyema; empyema tube; unexpandable lung