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A Randomized Trial of Empyema Therapy FREE TO VIEW

Michael A. Wait; Sashi Sharma; Joyce Hohn; Anthony Dal Nogare
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Affiliations: From the Division of Thoracic and Cardiovascular Surgery, Parkland Memorial Hospital, University of Texas Southwestern Medical Center, Dallas,  From the Pulmonary Medicine, Parkland Memorial Hospital, University of Texas Southwestern Medical Center, Dallas

Affiliations: From the Division of Thoracic and Cardiovascular Surgery, Parkland Memorial Hospital, University of Texas Southwestern Medical Center, Dallas,  From the Pulmonary Medicine, Parkland Memorial Hospital, University of Texas Southwestern Medical Center, Dallas


1997 by the American College of Chest Physicians


Chest. 1997;111(6):1548-1551. doi:10.1378/chest.111.6.1548
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Abstract

Study objectives: To determine the optimal treatment of empyema thoracis (within the fibrinopurulent phase of illness) comparing pleural drainage and fibrinolytic therapy vs video-assisted thoracoscopic surgery (VATS), with regard to efficacy and duration of hospitalization.

Design: Twenty patients with confirmed parapneumonic empyema thoracis were randomized to chest tube pleural drainage plus streptokinase (CT-SK) vs VATS.

Setting: University-based teaching hospital providing for Dallas County.

Patients and methods: Equivalent groups of patients with parapneumonic empyema thoracis were randomized to receive either of two therapies: CT-SK (n=9) or VATS (n=11). Outcomes analysis with respect to treatment efficacy, hospital duration, chest tube duration, hospital costs, and need for subsequent procedures was performed.

Results: Each group suffered one mortality (p=not significant). When compared with the CT-SK group, the VATS group had a significantly higher primary treatment success [10/11, 91% vs 4/9, 44%; p<0.05 Fisher's Exact Test], lower chest tube duration (5.8±1.1 vs 9.8±1.3 days; p=0.03), and lower number of total hospital days (8.7±0.9 vs 12.8±1.1 days; p=0.009). Clinically relevant but not statistically significant differences in hospital costs ($16,642±2,841 vs $24,052±3,466, p=0.11) also favored the VATS group. Of note, all the CT-SK treatment failures could be salvaged with VATS, and none required thoracotomy.

Conclusions: In patients with loculated, complex fibrinopurulent parapneumonic empyema thoracis, a primary treatment strategy of VATS is associated with a higher efficacy, shorter hospital duration, and less cost than a treatment strategy that utilizes catheter-directed fibrinolytic therapy.


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