Empyema surgery: Difference between revisions
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==Overview== | ==Overview== | ||
Definitive surgical treatment for empyema entails drainage of the infected pleural fluid. A [[chest tube]] may be inserted, often using ultrasound guidance. [[Intravenous]] [[antibiotic]]s are given. If this is insufficient, surgical [[debridement]] of the pleural space may be required.<ref name="pmid27815709">{{cite journal| author=Reichert M, Hecker M, Witte B, Bodner J, Padberg W, Weigand MA et al.| title=Stage-directed therapy of pleural empyema. | journal=Langenbecks Arch Surg | year= 2016 | volume= | issue= | pages= | pmid=27815709 | doi=10.1007/s00423-016-1498-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27815709 }} </ref><ref name="pmid11035692">{{cite journal| author=Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B et al.| title=Medical and surgical treatment of parapneumonic effusions : an evidence-based guideline. | journal=Chest | year= 2000 | volume= 118 | issue= 4 | pages= 1158-71 | pmid=11035692 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11035692 }} </ref><ref name="pmid2019172">{{cite journal| author=Ashbaugh DG| title=Empyema thoracis. Factors influencing morbidity and mortality. | journal=Chest | year= 1991 | volume= 99 | issue= 5 | pages= 1162-5 | pmid=2019172 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2019172 }} </ref>Management strategies of Empyema necessitans with pulmonary involvement and lung abscess may involve thoracotomy with pulmonary resection in addition to extended duration antimicrobial therapy.<ref name="pmid27180228">{{cite journal| author=Atay S, Banki F, Floyd C| title=Empyema necessitans caused by actinomycosis: A case report. | journal=Int J Surg Case Rep | year= 2016 | volume= 23 | issue= | pages= 182-5 | pmid=27180228 | doi=10.1016/j.ijscr.2016.04.005 | pmc=5022073 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27180228 }} </ref><ref name="pmid24326441">{{cite journal| author=Gomes MM, Alves M, Correia JB, Santos L| title=Empyema necessitans: very late complication of pulmonary tuberculosis. | journal=BMJ Case Rep | year= 2013 | volume= 2013 | issue= | pages= | pmid=24326441 | doi=10.1136/bcr-2013-202072 | pmc=3863066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326441 }} </ref> | |||
==Surgery== | ==Surgery== | ||
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*Drainage of fluid and pus | *Drainage of fluid and pus | ||
*Re-expansion of the lung | *Re-expansion of the lung | ||
Surgery should be considered without delay in the following patients:<ref name="pmid15745977">{{cite journal| author=Maskell NA, Davies CW, Nunn AJ, Hedley EL, Gleeson FV, Miller R et al.| title=U.K. Controlled trial of intrapleural streptokinase for pleural infection. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 9 | pages= 865-74 | pmid=15745977 | doi=10.1056/NEJMoa042473 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15745977 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16134914 Review in: ACP J Club. 2005 Sep-Oct;143(2):40] </ref><ref name="pmid15044206">{{cite journal| author=Diacon AH, Theron J, Schuurmans MM, Van de Wal BW, Bolliger CT| title=Intrapleural streptokinase for empyema and complicated parapneumonic effusions. | journal=Am J Respir Crit Care Med | year= 2004 | volume= 170 | issue= 1 | pages= 49-53 | pmid=15044206 | doi=10.1164/rccm.200312-1740OC | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15044206 }} </ref> | |||
*who fail to improve with antibiotics and chest tube drainage, | |||
*who have persistent infective symptoms, fever, leukocytosis and raised inflammatory markers. | |||
Contrary to popular belief, radiological clearance of pleural collection is not a good indicator of disease progress. | |||
===Surgery and Device Based Therapy=== | ===Surgery and Device Based Therapy=== | ||
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[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
Latest revision as of 17:39, 18 September 2017
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Empyema Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Definitive surgical treatment for empyema entails drainage of the infected pleural fluid. A chest tube may be inserted, often using ultrasound guidance. Intravenous antibiotics are given. If this is insufficient, surgical debridement of the pleural space may be required.[1][2][3]Management strategies of Empyema necessitans with pulmonary involvement and lung abscess may involve thoracotomy with pulmonary resection in addition to extended duration antimicrobial therapy.[4][5]
Surgery
Treatment of empyema focuses on the following:[1]
- Controlling the infectious focus
- Drainage of fluid and pus
- Re-expansion of the lung
Surgery should be considered without delay in the following patients:[6][7]
- who fail to improve with antibiotics and chest tube drainage,
- who have persistent infective symptoms, fever, leukocytosis and raised inflammatory markers.
Contrary to popular belief, radiological clearance of pleural collection is not a good indicator of disease progress.
Surgery and Device Based Therapy
Definitive surgical treatment for empyema entails drainage of the infected pleural fluid. A chest tube may be inserted, often using ultrasound guidance. Intravenous antibiotics are given. If this is insufficient, surgical debridement of the pleural space may be required.[1][2][3]
Empyema necessitans
Management strategies of Empyema necessitans with pulmonary involvement and lung abscess may involve thoracotomy with pulmonary resection in addition to extended duration antimicrobial therapy.[4][5]
References
- ↑ 1.0 1.1 1.2 Reichert M, Hecker M, Witte B, Bodner J, Padberg W, Weigand MA; et al. (2016). "Stage-directed therapy of pleural empyema". Langenbecks Arch Surg. doi:10.1007/s00423-016-1498-9. PMID 27815709.
- ↑ 2.0 2.1 Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B; et al. (2000). "Medical and surgical treatment of parapneumonic effusions : an evidence-based guideline". Chest. 118 (4): 1158–71. PMID 11035692.
- ↑ 3.0 3.1 Ashbaugh DG (1991). "Empyema thoracis. Factors influencing morbidity and mortality". Chest. 99 (5): 1162–5. PMID 2019172.
- ↑ 4.0 4.1 Atay S, Banki F, Floyd C (2016). "Empyema necessitans caused by actinomycosis: A case report". Int J Surg Case Rep. 23: 182–5. doi:10.1016/j.ijscr.2016.04.005. PMC 5022073. PMID 27180228.
- ↑ 5.0 5.1 Gomes MM, Alves M, Correia JB, Santos L (2013). "Empyema necessitans: very late complication of pulmonary tuberculosis". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-202072. PMC 3863066. PMID 24326441.
- ↑ Maskell NA, Davies CW, Nunn AJ, Hedley EL, Gleeson FV, Miller R; et al. (2005). "U.K. Controlled trial of intrapleural streptokinase for pleural infection". N Engl J Med. 352 (9): 865–74. doi:10.1056/NEJMoa042473. PMID 15745977. Review in: ACP J Club. 2005 Sep-Oct;143(2):40
- ↑ Diacon AH, Theron J, Schuurmans MM, Van de Wal BW, Bolliger CT (2004). "Intrapleural streptokinase for empyema and complicated parapneumonic effusions". Am J Respir Crit Care Med. 170 (1): 49–53. doi:10.1164/rccm.200312-1740OC. PMID 15044206.