Related Experiment Videos
A randomized trial of empyema therapy
1Division of Thoracic and Cardiovascular Surgery, Parkland Memorial Hospital, Dallas, TX 75235, USA. MWAIT@MEDNET.SWMED.EDU
Chest
|June 1, 1997
Summary
Video-assisted thoracoscopic surgery (VATS) offers superior efficacy and shorter hospital stays for empyema thoracis compared to chest tube drainage with fibrinolytic therapy. VATS is a more effective primary treatment strategy for complex cases.
Area of Science:
- Thoracic Surgery
- Pulmonology
- Infectious Diseases
Background:
- Empyema thoracis is a serious infection requiring prompt and effective treatment.
- The fibrinopurulent phase presents specific challenges for management.
- Optimal treatment strategies are crucial for patient outcomes.
Purpose of the Study:
- To compare the efficacy of video-assisted thoracoscopic surgery (VATS) against pleural drainage with fibrinolytic therapy for empyema thoracis.
- To evaluate the impact of each treatment on hospitalization duration.
Main Methods:
- A randomized trial involving 20 patients with confirmed parapneumonic empyema thoracis.
- Patients were assigned to either chest tube drainage plus streptokinase (CT-SK) or VATS.
- Outcomes assessed included treatment success, duration of chest tube and hospital stay, and costs.
Main Results:
- VATS demonstrated significantly higher primary treatment success (91% vs 44%) compared to CT-SK.
- The VATS group experienced shorter chest tube duration (5.8 vs 9.8 days) and fewer total hospital days (8.7 vs 12.8 days).
- While not statistically significant, hospital costs favored the VATS group.
Conclusions:
- VATS is a more effective primary treatment strategy for loculated, complex fibrinopurulent parapneumonic empyema thoracis.
- VATS leads to higher efficacy and shorter hospital durations compared to fibrinolytic therapy.
- All CT-SK treatment failures were successfully managed with subsequent VATS.