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The clinician's perspective on parapneumonic effusions and empyema
1Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston 29403-5851.
Chest
|January 1, 1993
Summary
Physician preferences for treating empyema (a type of pleural space infection) varied significantly. Decortication was favored for anaerobic multiloculated empyema, but further trials are needed to compare treatment options.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Empyema, a serious pleural space infection, presents complex management challenges.
- Treatment strategies for empyema have historically varied, lacking definitive comparative data.
Purpose of the Study:
- To assess the current management preferences of physicians for hypothetical empyema cases.
- To identify the range of preferred treatment modalities for multiloculated empyema.
Main Methods:
- A survey of 339 respondents at the 1991 American College of Chest Physicians Annual Scientific Assembly.
- Physicians indicated preferences for managing simulated patients with anaerobic multiloculated empyema and incompletely drained empyema.
Main Results:
- Pleural decortication was the most preferred treatment for anaerobic multiloculated empyema (49%).
- Other favored treatments included open thoracotomy with chest tube (22%) and intrapleural streptokinase (14%).
- For incompletely drained empyema, a second chest tube (small-bore 42%, large-bore 36%) was preferred.
Conclusions:
- Significant heterogeneity exists in physician preferences for empyema management.
- Prospective clinical trials are necessary to compare the efficacy of different treatment modalities for pleural space infections.