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Empyema thoracis

A G de la Rocha

    Surgery, Gynecology & Obstetrics
    |December 1, 1982
    PubMed
    Summary

    Empyema thoracis, a serious complication after thoracic surgery, requires meticulous surgical techniques and clinical judgment to reduce patient morbidity. Prompt drainage and appropriate antibiotic therapy are crucial for effective management in both adults and children.

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    Area of Science:

    • Thoracic Surgery
    • Infectious Diseases
    • Critical Care Medicine

    Background:

    • Empyema thoracis is a significant complication following thoracic surgery, particularly in adults.
    • High incidences of postpneumonectomy (15.5%) and postlobectomy (3.7%) empyema were observed in adult patients.
    • The exact causes for the high incidence of iatrogenic empyema remain undetermined.

    Purpose of the Study:

    • To report on the incidence, morbidity, and management of empyema thoracis in adult and pediatric populations.
    • To emphasize the importance of surgical technique and clinical judgment in preventing and managing thoracic surgical complications.
    • To outline effective treatment strategies for empyema thoracis, considering patient age and causative agents.

    Main Methods:

    • Retrospective analysis of 75 adult and 25 pediatric patients diagnosed with empyema thoracis.
    • Evaluation of morbidity through hospitalization duration (mean 56.8 days for adults, 22.6 days for pediatric patients).
    • Review of treatment approaches including surgical drainage, thoracentesis, chest tube placement, and antibiotic therapy guided by sensitivity testing.

    Main Results:

    • Adult patients exhibited a notable incidence of empyema post-pneumonectomy and post-lobectomy.
    • Extended hospitalization periods underscore the significant morbidity associated with empyema thoracis.
    • Pediatric patients generally required less invasive drainage methods like thoracentesis or chest tubes for recovery.

    Conclusions:

    • Impeccable surgical techniques and sound clinical judgment are paramount to minimize iatrogenic empyema and associated mortality/morbidity.
    • An aggressive approach to drain the empyemic space is essential for lung expansion and space sterilization.
    • Tailored antibiotic selection, considering bacterial and fungal pathogens, alongside close monitoring for superinfections, is critical for successful treatment.

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