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Rigid thorascopic debridement and continuous pleural irrigation in the management of empyema
R Karmy-Jones1, V Sorenson, H M Horst
1Division of Trauma/SICU, Henry Ford Hospital, Detroit, MI 48202, USA.
Study Objective:
To determine the role of rigid thoracoscopy and continuous pleural irrigation as an alternative to thoracotomy in critically ill patients. DESIGN/SETTING/PATIENTS/INTERVENTIONS: Thirteen patients with empyema (one bilateral) underwent thorascopic decortication and continuous postoperative irrigation with normal saline solution. Seven patients required preoperative ventilator support.
Measurements And Results:
Double-lumen intubation was utilized in only two cases. Empyemas were drained effectively in all patients, including nine patients in whom dense adhesions were encountered. Mean duration of irrigation was 3.5 +/- 0.5 days. There were no deaths. One patient developed a recurrent empyema 1 week after resolution of symptoms and underwent thoracotomy.
Conclusions:
Rigid thorascopic decortication is an effective method for treating empyemas and can be considered before thoracotomy. It can be performed in patients who might not be candidates for video-assisted thorascopic approaches owing to inability to tolerate one-lung anesthesia or who have dense adhesions preventing lung collapse.