U-shaped threshold-balanced extensive pleural lavage system for empyema: a retrospective case-control study on...

Pleural lavage and drainage is one of the important methods for treating empyema. However, traditional pleural lavage and drainage protocols have certain shortcomings. We have improved them and created the U-shaped threshold-balanced extensive pleural lavage drainage system (UTB-EPLDS). This study aimed to assess the clinical efficacy of UTB-EPLDS versus conventional irrigation methods in managing acute empyema.

This retrospective study analyzed 76 patients with acute empyema [2018-2024] categorized into three groups: UTB-EPLDS (n=26), closed drainage with intermittent lavage (IL, n=31), and closed drainage with open lavage (OL, n=19). Outcomes included drainage duration, infection markers, antibiotic use, hospitalization length, nursing workload, and protocol failure rates.

The UTB group demonstrated significantly shorter the duration of drainage tube retention (UTB 17.92±2.06 vs. IL 26.13±5.09 vs. OL 31.37±6.28 days; P<0.001), the time to normalization of peripheral blood C-reactive protein (CRP) {9.00 [interquartile range (IQR), 8.00-11.00] vs. 11.00 (IQR, 9.00-12.00) vs. 13.00 (IQR, 12.00-14.00) days; P<0.001}, the duration of antibiotic use [12.00 (IQR, 11.00-14.00) vs. 14.00 (IQR, 12.00-15.00) vs. 16.00 (IQR, 15.00-17.00) days; P<0.001], and the length of hospital (22.38±3.31 vs. 30.48±5.50 vs. 36.26±6.40 days; P<0.001) versus comparators. UTB-EPLDS achieved equivalent time to normalization of leukocyte count in drainage fluid to OL [5.00 (IQR, 3.75-7.00) vs. 5.00 (IQR, 3.00-7.00) days; P=0.62] with lower nursing interventions than IL [6.00 (IQR, 5.00-6.00) vs. 7.00 (IQR, 6.00-7.00); P<0.001]. No drainage protocol change occurred in the UTB group versus 19.4% and 26.3% crossovers from IL and OL groups, respectively. Complication rates were comparable (7.7% vs. 3.2% vs. 5.3%; P=0.57).

UTB-EPLDS enhances empyema management through dynamic threshold-balanced delayed drainage synchronized with postural changes, achieving superior infection control and accelerated recovery compared to traditional lavage methods. Its automated design minimizes nursing workload while maintaining clinical stability, supporting its potential as a first-line irrigation-drainage strategy.