Patients with an primary empyema,lung abcess,or post-pneumonectomy empyema, who are critically ill, may only tolerate surgical drainage of the infection. A study was undertaken to examine the outcome of patients who had a complex intra-thoracic infection managed by rib resection and the creation of an open chest window.
A retrospective review was undertaken of all patients presenting to a single institution with a complex intra-thoracic infection and who were treated with a rib resection and creation of a chest window.
Between 1998 and 2005, a total of 35 patients (8 females, 27 males, average age 59 years) were treated in this fashion. There was insufficient data available for 3 patients. Twelve patients (34%) presented with a primary intra-thoracic infection (PII). Twenty patients (57%), developed an intra-thoracic infection secondary to an obstructing lung cancer or following a recent thoracotomy and pulmonary resection(SII). Average post-operative length of stay was 13 days (median 7.5 days). There were 5 postoperative deaths (14.3%); 4(SII)patients(2 died from sepsis,1 from hemorrhage,1 from other cause) and 1 (PII) patient died from sepsis. Eight (SII) patients (23%) died after discharge from hospital from non- septic causes. Primary closure of the window was successfully performed in 2 (SII) patients (average time to closure-15.5 months) and 5 (PII) patients (13.2 months). Closure of the window by secondary healing occurred in 5 (SII) and 3 (PII) patients. Windows presently remain open or were open until death in 9 (SII) patients and 3 (PII) patients.
The open chest window technique successfully managed the intra-thoracic infection in 84% of the patients. It is associated with acceptable post operative mortality and length of hospital stay. Closure of the window, either by surgery or by secondary healing, can be accomplished in large percentage of patients.
The use of the open chest window to manage the desparately ill patient, with a complex intra-thoracic infection, remains an effective treatment strategy.
Robin Varghese, None.