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Surgical interventions for pleural infection.

Maria Giovanna Mastromarino1, Alessandra Lenzini1, Giacomo Rabazzi2

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Breathe (Sheffield, England)
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Pleural infection (PI) management involves antibiotics and drainage, with surgery crucial for advanced cases. This review details surgical options like VATS and open decortication, emphasizing a multidisciplinary approach for better patient outcomes.

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Area of Science:

  • Thoracic Surgery
  • Infectious Diseases
  • Pulmonology

Background:

  • Pleural infection (PI) presents significant morbidity, mortality, and prolonged hospitalization.
  • Antimicrobial resistance complicates PI treatment, necessitating advanced interventions.
  • Current first-line treatments include antibiotics and drainage, but surgical options are vital for refractory cases.

Purpose of the Study:

  • To review the spectrum of surgical strategies for managing pleural infection.
  • To highlight indications, timing, and evolving roles of surgical techniques.
  • To emphasize the importance of post-operative care and a multidisciplinary approach.

Main Methods:

  • Narrative review of surgical strategies for pleural infection.
  • Exploration of Video-Assisted Thoracoscopic Surgery (VATS), open decortication, and other techniques.
  • Discussion of prognostic tools like the RAPID score for risk stratification.

Main Results:

  • VATS is preferred for early-stage PI, offering minimally invasive benefits.
  • Open decortication or thoracotomy may be required for complex or advanced PI.
  • Post-operative care, including rehabilitation and nutritional support, is critical for recovery.

Conclusions:

  • A patient-centered, multimodal treatment strategy tailored to disease stage is essential for successful PI management.
  • A multidisciplinary team approach is crucial for optimizing patient care.
  • Further research into long-term outcomes and diagnostics is needed to improve PI treatment.