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The Pediatric Infectious Disease Journal Aug 1999
Review
Topics: Adolescent; Adult; Child; Empyema, Pleural; Humans; Infant; Pleural Effusion
PubMed: 10462345
DOI: 10.1097/00006454-199908000-00015 -
Clinics in Chest Medicine Dec 2021The rising incidence and high morbidity of pleural infection remain a significant challenge to health care systems worldwide. With distinct microbiology and treatment... (Review)
Review
The rising incidence and high morbidity of pleural infection remain a significant challenge to health care systems worldwide. With distinct microbiology and treatment paradigms from pneumonia, pleural infection is an area in which the evidence base has been rapidly evolving. Progress in recent years has revolved around characterizing the microbiome of pleural infection and the addition of new strategies such as intrapleural enzyme therapy to the established treatment pathway of drainage and antibiotics. The future of improving outcomes lies with personalizing treatment, establishing optimal timing of intrapleural agents and surgery, alongside wider use of risk stratification to guide treatment.
Topics: Empyema, Pleural; Fibrinolytic Agents; Humans; Pleural Effusion; Pneumonia; Thrombolytic Therapy
PubMed: 34774171
DOI: 10.1016/j.ccm.2021.08.001 -
The New England Journal of Medicine Feb 2018
Review
Topics: Diagnosis, Differential; Empyema, Pleural; Exudates and Transudates; Humans; Pleura; Pleural Effusion; Pleural Effusion, Malignant; Pneumothorax
PubMed: 29466146
DOI: 10.1056/NEJMra1403503 -
Clinical Infectious Diseases : An... May 1996
Review
Topics: Adult; Animals; Anti-Infective Agents; Bacterial Infections; Child; Combined Modality Therapy; Debridement; Disease Models, Animal; Drainage; Empyema, Pleural; Humans; Prognosis; Thrombolytic Therapy
PubMed: 8722927
DOI: 10.1093/clinids/22.5.747 -
Langenbeck's Archives of Surgery Feb 2017Intensivists and surgeons are often confronted with critically ill patients suffering from pleural empyema. Due to it' s multifactorial pathogenesis and etiology,... (Review)
Review
PURPOSE
Intensivists and surgeons are often confronted with critically ill patients suffering from pleural empyema. Due to it' s multifactorial pathogenesis and etiology, medicals should be sensitized to recognize the different stages of the disease. Besides a whole bundle of different established classification systems, the progress of pleural effusions can be subdivided into the early exudative, the intermediate fibropurulent and the late organized phase according to the classification of the American Thoracic Society.
RESULTS
Rapid diagnosis of pleura empyema is essential for patients' survival. Due to the importance of stage-adapted therapeutic decisions, different classification systems were established. Depending on the stage of pleural empyema, both antimicrobial and interventional approaches are indicated. For organized empyema, minimally invasive and open thoracic surgery are gold standard. Surgery is based on the three therapeutic columns: removal of pleural fluid, debridement and decortication. In general, therapy must be intended stage-directed following multidisciplinary concepts including surgeons, intensivists, anesthesiologists, physiotherapists and antibiotic stewards. Despite an established therapeutic algorithm is presented in this review, there is still a lack of randomized, prospective studies to evaluate potential benefits of minimally invasive (versus open) surgery for end-stage empyema or of catheter-directed intrathoracic fibrinolysis (versus minimally invasive surgery) for intermediate-stage pleural empyema. Any delay in adequate therapy results in an increased morbidity and mortality.
CONCLUSION
The aim of this article is to review current treatment standards for different phases of adult thoracic empyema from an interdisciplinary point of view.
Topics: Adult; Empyema, Pleural; Humans
PubMed: 27815709
DOI: 10.1007/s00423-016-1498-9 -
Folia Medica Sep 2019Pleural empyema after pneumonectomy still poses a serious postoperative complication. A broncho-pleural fistula is often detected. Despite various therapeutic options... (Review)
Review
BACKGROUND
Pleural empyema after pneumonectomy still poses a serious postoperative complication. A broncho-pleural fistula is often detected. Despite various therapeutic options developed over the last five decades it remains a major surgical challenge.
MATERIALS AND METHODS
A literature search in MEDLINE database was carried out (accessed through PubMed), by using a combination of the following key-words and MeSH terms: pneumonectomy, postoperative, complications, broncho-pleural fistula, empyema, prevention. The following areas of intervention were identified: epidemiology, etiology, prevention.
RESULTS
Pleural empyema in a post-pneumonectomy cavity occurs in up to 16% of patients with a mortality of more than 10%. It is associated with broncho-pleural fistula in up to 80% of them, usually in the early postoperative months. Operative mortality could reach 50% in case of broncho-pleural fistula. Unfavourable prognostic factors are: benign disease, COPD, right-sided surgery, neoadjuvant and adjuvant therapy, time of chest tube removal, long bronchial stump and mechanical ventilation. Bronchial stump protection with vascularised flaps is of utmost importance in the prevention of complications.
CONCLUSION
Postpneumonectomy pleural empyema is a common complication with high mortality. The existing evidence confirms the role of bronchopleural fistula prevention in the prevention of life-threatening complications.
Topics: Empyema, Pleural; Humans; Pneumonectomy; Postoperative Complications; Surgical Flaps; Sutures
PubMed: 32337920
DOI: 10.3897/folmed.61.e39120 -
Der Chirurg; Zeitschrift Fur Alle... Aug 1998Thoracic empyema may be based on four different etiologic mechanisms of infection: (1) parapneumonic, (2) posttraumatic, (3) postspecific, (4) postsurgical. According to... (Review)
Review
Thoracic empyema may be based on four different etiologic mechanisms of infection: (1) parapneumonic, (2) posttraumatic, (3) postspecific, (4) postsurgical. According to morphologic processes, three different time-dependent stages may be present: (1) exudative phase, (2) fibrino-purulent phase, (3) organization and pleural peel formation. Diagnosis and pleural puncture are based on the findings of thoracic CT and transthoracic ultrasonography. Thoracocentesis, however--even if performed repeatedly--is not an appropriate treatment of empyema. Chest tube drainage and irrigation of the pleural cavity is appropriate only in stage I and early stage II disease to re-establish total lung inflation and healing without pleural peel formation. Selected stage II cases may benefit from video-assisted debridement, but a 30% conversion rate to open thoracotomy has to be assumed. Residual organized cavities, loculated peels etc. require open thoracotomy and empyemectomy, decortication or combined maneuvers. For treatment quality and outcome it is not only decisive to remove the source of infection but also to reexpand the entire lung without remaining restrictive peels and without relevant leaks.
Topics: Chest Tubes; Debridement; Empyema, Pleural; Humans; Thoracotomy; Tomography, X-Ray Computed; Ultrasonography
PubMed: 9782398
DOI: 10.1007/s001040050496 -
Monaldi Archives For Chest Disease =... Sep 2010Empyema is defined as pus in the thoracic cavity due to pleural space infection and has a multifactorial underlying cause, although the majority of cases are... (Review)
Review
Empyema is defined as pus in the thoracic cavity due to pleural space infection and has a multifactorial underlying cause, although the majority of cases are post-bacterial pneumonia. Despite treatment with antibiotics, patients with empyema have a considerable morbidity and mortality due at least in part to inappropriate management of the effusion. Timely diagnosis of pleural space infection and rapid initiation of effective pleural drainage represent fundamental principles for managing patients with empyema. Ultrasound is particularly useful to identify early fibrin membranes and septations in the pleural cavity conditioning treatment strategy. Empyema and large or loculated effusion with a pH < 7.20 need to be drained. Thoracoscopy has largely been used in pleural effusion due to lung infection. Whereas the efficacy of video-assisted thoracic surgery (VATS) in empyema management has been evaluated in several retrospective studies showing favourable results, less is known about the role of medical thoracoscopy (MT) in pleural infection. MT, appears to be safe and successful in multiloculated empyema treatment. It is also lower in cost and in frail patients is better tolerated than VATS which requires tracheal intubation.
Topics: Anti-Bacterial Agents; Chest Tubes; Combined Modality Therapy; Drainage; Empyema, Pleural; Humans; Thoracic Surgery, Video-Assisted
PubMed: 21214042
DOI: 10.4081/monaldi.2010.296 -
Journal de Mycologie Medicale Nov 2022Aspergillus species are ubiquitous saprophytic fungi that are present in the air, water, soil, and decaying vegetables. Clinical features of Aspergillus infection... (Review)
Review
Aspergillus species are ubiquitous saprophytic fungi that are present in the air, water, soil, and decaying vegetables. Clinical features of Aspergillus infection largely depend on the interplay between the fungi and the host immune status. We present a case of a chronic smoker with shortness of breath who was found to have diffuse bronchiectatic changes and empyema of the right lung. Emphysema was also noticed in the left lung. Rare Aspergillus fumigatus was identified in the pleural fluid, while the acid-fast stain and bacterial cultures were negative. The patient's serum Aspergillus fumigatus IgG antibody and galactomannan antigen were negative; however, the pleural galactomannan antigen was elevated. He was treated with video-assisted thoracoscopic surgery (VATS) and partial decortication of the right lung, along with intravenous voriconazole. Despite aggressive therapeutic measures, he died after a prolonged hospital stay. Aspergillus pleural empyema is rare but can be fatal; however, it is not included in the classification for pulmonary aspergillosis. Clinicians should be vigilant to evaluate for fungal empyema in patients with chronic obstructive pulmonary diseases, even without profound immunosuppression.
Topics: Humans; Male; Smokers; Empyema, Pleural; Voriconazole; Aspergillosis; Aspergillus
PubMed: 35640524
DOI: 10.1016/j.mycmed.2022.101299 -
Thorax Jul 2021
Topics: Aged; Anti-Bacterial Agents; Empyema, Pleural; Female; Humans; Pyelonephritis, Xanthogranulomatous; Tomography, X-Ray Computed
PubMed: 33115938
DOI: 10.1136/thoraxjnl-2020-215786