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Rigid Thorascopic Debridement and Continuous Pleural Irrigation in the Management of Empyema

Riyad Karmy-Jones; Victor Sorenson; H. Mathilda Horst; Joseph W. Lewis, Jr.; Ilan Rubinfeld
Author and Funding Information

Affiliations: From the Divisions of Trauma/SICU and Cardiothoracic Surgery, Henry Ford Hospital, Detroit,  From the Division of Trauma/SICU, Henry Ford Hospital, Detroit,  From the Division of Cardiothoracic Surgery, Henry Ford Hospital, Detroit

Affiliations: From the Divisions of Trauma/SICU and Cardiothoracic Surgery, Henry Ford Hospital, Detroit,  From the Division of Trauma/SICU, Henry Ford Hospital, Detroit,  From the Division of Cardiothoracic Surgery, Henry Ford Hospital, Detroit

Affiliations: From the Divisions of Trauma/SICU and Cardiothoracic Surgery, Henry Ford Hospital, Detroit,  From the Division of Trauma/SICU, Henry Ford Hospital, Detroit,  From the Division of Cardiothoracic Surgery, Henry Ford Hospital, Detroit


1997 by the American College of Chest Physicians


Chest. 1997;111(2):272-274. doi:10.1378/chest.111.2.272
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Published online

Abstract

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.


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