Empyema – Leczenie

Empyema
Leczenie

Empyema, czyli ropniak opłucnej, wymaga szybkiej i kompleksowej interwencji obejmującej eradykację zakażenia, drenaż jamy opłucnej oraz przywrócenie funkcji płuc. Leczenie opiera się na empirycznej, szerokospektralnej antybiotykoterapii, uwzględniającej patogeny takie jak MRSA, Pseudomonas i bakterie beztlenowe, z opcjami takimi jak wankomycyna, metronidazol, cefalosporyny przeciwpseudomonalne, klindamycyna czy karbapenemy. Czas terapii antybiotykowej wynosi od 1-2 tygodni w niepowikłanych wysiękach do 4-6 tygodni w empyemach. Kluczowy jest natychmiastowy drenaż jamy opłucnej – od torakocentezy w stadium wczesnym do założenia drenów w bardziej zaawansowanych przypadkach. Drenaż należy kontynuować do momentu, gdy odpływ płynu spadnie poniżej 100 ml/dobę (wysięk prosty) lub 50 ml/dobę (empyema). W przypadku zlokalizowanych wysięków stosuje się wewnątrzopłucnową terapię fibrynolityczną (np. tPA 10 mg i DNaza 5 mg dwa razy dziennie przez 3 dni), co poprawia drenaż i zmniejsza potrzebę operacji.

Leczenie empyemy – podejście ogólne

Empyema, czyli ropniak opłucnej, charakteryzuje się obecnością ropy w jamie opłucnej i stanowi poważne powikłanie wymagające szybkiej interwencji. Główne cele leczenia empyemy obejmują eradykację zakażenia poprzez odpowiednią antybiotykoterapię, zapewnienie adekwatnego drenażu jamy opłucnej oraz przywrócenie prawidłowej funkcji płuc¹². Wczesne i agresywne postępowanie ma kluczowe znaczenie dla poprawy wyników leczenia i minimalizacji powikłań³.

Wybór odpowiedniego leczenia zależy od stadium empyemy, stanu klinicznego pacjenta oraz lokalnych możliwości. American Association for Thoracic Surgery (AATS) rekomenduje następujące opcje terapeutyczne: leczenie antybiotykami, drenaż z użyciem drenów lub cewników pod kontrolą tomografii komputerowej, wewnątrzopłucnową terapię fibrynolityczną, torakotomię z dekortykacją oraz chirurgię wideotorakoskopową (VATS)⁴. Generalnie, pacjenci z wczesnym stadium empyemy są leczeni za pomocą drenażu opłucnowego, pacjenci z chorobą w stadium włóknikowo-ropnym mogą być leczeni terapią fibrynolityczną lub VATS, natomiast pacjenci z późnym stadium empyemy wymagają dekortykacji⁵.

Antybiotykoterapia w leczeniu empyemy

Antybiotykoterapia stanowi podstawę leczenia empyemy i powinna być rozpoczęta jak najszybciej po postawieniu diagnozy¹². Początkowo stosuje się empiryczną szerokospektralną antybiotykoterapię, którą następnie modyfikuje się na podstawie wyników posiewów i antybiogramów¹.

Dobór antybiotyków

W terapii empirycznej należy uwzględnić potencjalne patogeny, w tym metycylinooporne szczepy Staphylococcus aureus, Pseudomonas oraz bakterie beztlenowe¹. Racjonalnymi opcjami są: wankomycyna plus metronidazol i cefalosporyna o działaniu przeciwpseudomonalnym². Alternatywnie, można zastosować klindamycynę, karbapenemy lub połączenie beta-laktamów z inhibitorami beta-laktamaz, jak piperacylina z tazobaktamem¹.

Dostosowanie antybiotykoterapii zależy od zidentyfikowanego patogenu i jego wrażliwości na antybiotyki¹. Dobra penetracja do płynu opłucnowego i ropniaka została udokumentowana dla penicylin, ceftriaksonu, metronidazolu, klindamycyny, wankomycyny, gentamycyny i ciprofloksacyny¹.

Czas trwania antybiotykoterapii

Czas trwania leczenia antybiotykami zależy od rodzaju wysięku, przy czym niepowikłany wysięk wymaga 1-2 tygodni leczenia, powikłany wysięk 2-3 tygodni, a empyema 4-6 tygodni¹². Przejście na antybiotyki doustne można rozważyć po uzyskaniu poprawy klinicznej i obiektywnej (odpowiedni drenaż i usunięcie drenu, zmniejszenie CRP, normalizacja temperatury)¹.

Drenaż jamy opłucnej

Drenaż jamy opłucnej stanowi kluczowy element leczenia empyemy i powinien być wykonany niezwłocznie po potwierdzeniu diagnozy¹². Opóźnienie w drenażu może prowadzić do tworzenia się zlokalizowanego płynu opłucnowego¹.

Torakocenteza

W prostych przypadkach, zwłaszcza we wczesnym stadium empyemy, można wykonać przezskórną torakocentezę (thoracentesis), polegającą na wprowadzeniu igły do jamy opłucnowej w celu usunięcia płynu¹². Procedura ta ma zarówno znaczenie diagnostyczne, jak i terapeutyczne¹.

Drenaż klatki piersiowej

W bardziej zaawansowanych przypadkach lub gdy torakocenteza nie jest wystarczająca, konieczne jest założenie drenu do klatki piersiowej (tube thoracostomy)¹². Drenaż z zastosowaniem małych drenów okazał się bezpieczną i skuteczną metodą leczenia wczesnego stadium empyemy¹. Nie ma konsensusu co do optymalnej wielkości drenu lub cewnika, a zalecenia w różnych wytycznych się różnią¹.

Drenaż klatki piersiowej powinien być kontynuowany tak długo, jak długo obserwuje się poprawę kliniczną i radiologiczną¹. Jeśli pacjent nie wykazuje poprawy klinicznej lub radiologicznej przy zmniejszającym się drenażu płynu opłucnowego, należy wykonać badanie ultrasonograficzne jamy opłucnej lub tomografię komputerową klatki piersiowej, aby sprawdzić obecność zlokalizowanego płynu opłucnowego i upewnić się co do prawidłowego umieszczenia drenu².

Drenaż klatki piersiowej jest skuteczny w przypadku nieseptowanych zbiorników płynu¹. Drenaż należy usunąć, gdy objętość odpływu wynosi poniżej 100 ml/dobę dla czystych wysięków i poniżej 50 ml/dobę dla empyemy².

Wewnątrzopłucnowa terapia fibrynolityczna

Zastosowanie terapii fibrynolitycznej stanowi uzupełnienie drenażu klatki piersiowej w przypadku zlokalizowanego, powikłanego wysięku opłucnowego lub empyemy¹². Wewnątrzopłucnowa fibrynoliza obejmuje stosowanie środków fibrynolitycznych w celu rozpuszczenia skrzepów fibrynowych i błon¹.

Środki fibrynolityczne i protokoły leczenia

Od lat 70. XX wieku wiele badań wykazało skuteczność terapii trombolitycznej w leczeniu zlokalizowanych, powikłanych wysięków opłucnowych¹. Środki fibrynolityczne stosowane w leczeniu opłucnowych wysięków parapneumonicznych są bardziej skuteczne, jeśli są podawane we wczesnym stadium włóknikowo-ropnym².

Szeroko stosowanymi środkami fibrynolitycznymi są: streptokinaza, urokinaza lub tkankowy aktywator plazminogenu (tPA)¹. Najnowsze badania wykazały, że terapia skojarzona z tPA i deoksyrybonukleazą (DNaza) znacząco poprawia drenaż płynu, zmniejsza liczbę skierowań do operacji i skraca pobyt w szpitalu bez wpływu na śmiertelność².

Często stosowany schemat obejmuje podanie 10 mg tPA i 5 mg DNazy wstrzykiwanych przez dren klatki piersiowej dwa razy dziennie przez 3 dni¹. Lek pozostawia się w jamie opłucnej na około godzinę, a następnie zapewnia się drenaż¹.

Skuteczność terapii fibrynolitycznej

Pierwsze badanie MIST (MIST1) było prospektywnym, randomizowanym badaniem z podwójnie ślepą próbą, w którym pacjenci z zakażeniem opłucnej otrzymywali albo wewnątrzopłucną streptokinazę (250 000 IU dwa razy dziennie przez 3 dni), albo placebo, oprócz antybiotyków, drenażu klatki piersiowej, operacji i innego rutynowego leczenia¹. Metaanaliza nie poparła rutynowego stosowania terapii trombolitycznej u wszystkich pacjentów wymagających drenażu klatki piersiowej z powodu empyemy lub powikłanego wysięku opłucnowego¹.

Jednak późniejsze badanie MIST2 wykazało skuteczność połączenia tPA i DNazy, a terapia fibrynolityczna pozostaje ważną opcją leczenia, szczególnie u pacjentów z wysokim ryzykiem operacyjnym i we względnie wczesnych stadiach (stadium 1 i do pewnego stopnia stadium 2)¹.

Leczenie chirurgiczne empyemy

Leczenie chirurgiczne jest wskazane, gdy nie następuje poprawa po leczeniu zachowawczym lub gdy empyema jest w zaawansowanym stadium¹. Celem leczenia chirurgicznego jest szybkie ustanowienie skutecznego drenażu opłucnowego i promowanie rozprężenia płuc w celu zamknięcia przestrzeni empyemy¹.

Wideotorakoskopia (VATS)

Wideotorakoskopia (VATS) jest minimalnie inwazyjną techniką chirurgiczną, która umożliwia bezpośrednią wizualizację i opróżnienie zakażonej przestrzeni opłucnowej¹. VATS jest obecnie preferowaną metodą leczenia chirurgicznego empyemy w porównaniu z tradycyjną torakotomią¹.

VATS polega na ewakuacji przez odsysanie, przerwaniu włóknistych przegród opłucnowych i oderwaniu zrostów, aż przestrzeń empyemy stanie się pojedynczą przestrzenią¹. Zaletami VATS są: mniejsza inwazyjność, lepsza kontrola bólu pooperacyjnego, mniejsze upośledzenie oddechowe i zmniejszenie powikłań pooperacyjnych, w tym 30-dniowej śmiertelności².

W porównaniu z torakotomią otwartą, VATS w przypadku empyemy w stadium II/III może skrócić czas operacji i długość pobytu w szpitalu bez pogorszenia skuteczności leczenia, powikłań i śmiertelności po operacji¹.

Dekortykacja

Dekortykacja obejmuje usunięcie całej tkanki włóknistej z opłucnej trzewnej i ściennej wraz z ropą z jamy opłucnowej¹. Eliminuje zakażenie opłucnowe i w ten sposób wspomaga rozprężenie płuca².

Operacja dekortykacji może być wykonana techniką VATS lub poprzez torakotomię otwartą¹. W zaawansowanych przypadkach empyemy i zwłóknienia opłucnej konieczna jest torakotomia w celu uwolnienia uwięźniętego płuca¹.

Torakotomia

Torakotomia jest bardziej inwazyjną procedurą niż VATS i wiąże się z dłuższym czasem rekonwalescencji¹. Jednak w niektórych przypadkach, takich jak przetrwała empyema oporna na standardowe terapie, w tym VATS, należy rozważyć otwartą torakotomię z długotrwałym drenażem klatki piersiowej lub dekortykacją¹.

Jeśli zakażony materiał nie może zostać usunięty lub płuco nie może zostać całkowicie rozprężone, zaleca się konwersję do torakotomii, aby osiągnąć te dwa cele¹.

Strategie leczenia w różnych stadiach empyemy

Leczenie empyemy zależy od jej stadium w momencie rozpoznania¹. Klasycznie wyróżnia się trzy fazy empyemy¹:

Faza wysiękowa (Stadium I)

Faza wysiękowa (Stadium I) występuje w ciągu pierwszych 1-2 tygodni choroby, gdy płyn swobodnie przemieszcza się w klatce piersiowej i towarzyszy zapaleniu opłucnej¹. Na tym etapie prosty drenaż za pomocą drenu klatki piersiowej i dożylna antybiotykoterapia są zwykle wystarczające do leczenia².

Faza włóknisto-ropna (Stadium II)

Faza włóknisto-ropna (Stadium II) w tygodniach 1-4 charakteryzuje się ropnym wysiękiem i złogami włóknikowymi na powierzchni opłucnej¹. Na tym etapie sam drenaż rurowy nie jest skuteczny. Stadium to wymaga usunięcia włóknisto-ropnych złogów i drenażu zakażonego płynu². W fazie włóknisto-ropnej można zastosować terapię fibrynolityczną lub VATS¹.

Faza włóknista (Stadium III)

Fazy włóknistej (Stadium III) najlepiej unikać, NIE OPÓŹNIAJĄC drenażu we wcześniejszych stadiach¹. Torakotomia i otwarta dekortykacja są zwykle wymagane do osiągnięcia pełnej dekortykacji i rozprężenia płuca².

Powikłania empyemy mają tendencję do występowania w stadium przewlekłym i mogą objawiać się jako przetoka oskrzelowo-opłucnowa, ropień wewnątrzklatkowy, zapalenie osierdzia, zapalenie szpiku kostnego¹.

Szczególne populacje pacjentów z empyemą

Pacjenci w ciężkim stanie z chorobami współistniejącymi

Pacjenci z empyemą w złym stanie fizycznym i ciężkimi chorobami współistniejącymi stanowią znaczące wyzwanie, z trudnościami w wyborze odpowiednich metod leczenia, ograniczonymi wynikami leczenia oraz wysokim wskaźnikiem powikłań i śmiertelności¹.

Zastosowanie VATS do oczyszczenia jamy opłucnowej w połączeniu ze stopniowo wycofywanym drenem do leczenia podostrego i ostrego stadium empyemy u pacjentów z ciężkimi chorobami współistniejącymi przyniosło pozytywne wyniki¹. Podejście to wykazało wysoką skuteczność, bezpieczeństwo i łagodne powikłania o niskiej częstości występowania (8,3%)².

Dzieci z empyemą

W populacji pediatrycznej nie ma ustalonego standardowego schematu leczenia empyemy¹. Aktualna literatura sugeruje, że nie ma istotnej różnicy w wynikach między drenem klatki piersiowej z wewnątrzopłucnowymi fibrynolitykami a VATS².

Dren klatki piersiowej i wewnątrzopłucnowe fibrynolityki mogą oferować te same korzyści kliniczne, ale przy niższych kosztach³. W niektórych ośrodkach dren klatki piersiowej plus fibrynoliza jest preferowaną opcją dla dzieci/młodzieży z empyemą opłucnową wymagającą drenażu, chyba że szczególne okoliczności wskazują inaczej¹.

Wewnątrzopłucnowy alteplaza (tkankowy aktywator plazminogenu, tPA) powinien być podawany od początku, jeśli uzyskany płyn opłucnowy jest mętny lub istnieją dowody na lokalizację w badaniu ultrasonograficznym². Typowa dawka to 4 mg w 30-50 ml soli fizjologicznej dziennie przez okres do trzech dni¹.

Nowe podejścia terapeutyczne w leczeniu empyemy

Pomimo ustalonych schematów leczenia, istnieje ciągła potrzeba opracowania nowych, minimalnie inwazyjnych metod leczenia empyemy, szczególnie w przypadkach opornych na standardowe terapie¹.

Wewnątrzopłucnowa antybiotykoterapia

Wewnątrzopłucnowa antybiotykoterapia stanowi obiecującą metodę leczenia ropniaka opłucnowego¹. Miejscowe podawanie wewnątrzklatkowe zwiększa stężenie leku w lokalnych tkankach. Jako uzupełnienie dożylnej terapii przeciwzakaźnej, wewnątrzklatkowe wstrzyknięcie antybiotyku poprawia eliminację bakterii i sprzyja absorpcji w zainfekowanej klatce piersiowej².

Chociaż dowody dotyczące antybiotyków wewnątrzopłucnowych są ograniczone, głównie do opisów przypadków lub serii przypadków, zachęcające wyniki wskazują, że antybiotyki wewnątrzopłucnowe są obiecującym obszarem przyszłych badań¹. Wstrzyknięcie do opłucnej można zaproponować, gdy torakocenteza z ogólnoustrojową antybiotykoterapią zawiodła i gdy operacja nie może być przeprowadzona z powodu chorób współistniejących lub odmowy pacjenta².

Rokowanie i obserwacja pacjentów z empyemą

Rokowanie w przypadku empyemy z szybkim leczeniem jest dobre. Długotrwałe uszkodzenie płuc jest rzadkie¹. Pacjenci powinni zakończyć przepisane antybiotyki i zgłosić się na kontrolne zdjęcie rentgenowskie klatki piersiowej. Lekarz może upewnić się, że opłucna zagoiła się prawidłowo².

Jednak u osób z innymi schorzeniami, które osłabiają układ odpornościowy, empyema może mieć wskaźnik śmiertelności sięgający 40%³. Jeśli nie jest leczona, empyema może prowadzić do potencjalnie zagrażających życiu powikłań, takich jak sepsa⁴.

Wielu pacjentów zaczyna czuć się lepiej w ciągu kilku dni od rozpoczęcia leczenia empyemy. Ból w klatce piersiowej i duszność często poprawiają się po drenażu zakażonego płynu. Zmęczenie i kaszel mogą utrzymywać się przez kilka tygodni. Większość osób jest w stanie powrócić do normalnej aktywności po 2-4 tygodniach, ale pełna rekonwalescencja może trwać kilka miesięcy¹.

Podsumowanie zasad leczenia empyemy

Skuteczne leczenie empyemy wymaga kontroli zakażenia, drenażu ropy i rozprężenia płuc¹. Trzy główne zasady leczenia empyemy to: ewakuacja wysięku z jamy opłucnowej, celowana antybiotykoterapia oraz leczenie wspomagające (fizjoterapia, leczenie żywieniowe itp.)¹.

Wczesna inicjacja antybiotyków, albo samodzielnie, albo w połączeniu z procedurą drenażu, jest zalecana dla wszystkich pacjentów¹. Wczesna interwencja proceduralna jest zalecana, jeśli pacjent ma umiarkowane do ciężkiego zaburzenia oddechowe (nasilająca się tachypnoe, wysiłek oddechowy i/lub hipoksja), ponieważ płyn opłucnowy często zajmuje większość półklatki piersiowej i może nawet powodować przesunięcie śródpiersia².

Szybka diagnoza i drenaż zakażenia przestrzeni opłucnowej są kluczowe w leczeniu i postępowaniu z empyemą¹. Opóźnienie leczenia wiąże się z wysoką chorobowością i śmiertelnością¹.

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Materiały źródłowe

#1 Thoracic Empyema – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK544279/
Thoracic empyema, characterized by the presence of purulent fluid in the pleural space, remains a significant clinical challenge with considerable morbidity and mortality. Early diagnosis and aggressive management, including antimicrobial therapy, drainage procedures, and sometimes surgery, are critical for favorable outcomes. […] The integration of evidence-based practices, including the role of intrapleural enzyme therapy, surgical interventions, and antimicrobial stewardship, is emphasized to equip clinicians better to deliver timely and effective care and reduce the burden of this challenging condition. […] The treatment and management of thoracic empyema involve a combination of medical and surgical interventions aimed at eradicating infection, achieving adequate drainage of the pleural space, and restoring lung function. Early and aggressive management is critical to improving outcomes and minimizing complications. […] Management aims to eradicate infection through antimicrobials and achieve adequate pleural drainage using tube thoracostomy, with or without intrapleural therapies, video-assisted thoracoscopic surgery (VATS), or open thoracotomy with decortication.
#1 Empyema: Causes, Symptoms, Diagnosis & Treatment
https://my.clevelandclinic.org/health/diseases/24269-empyema
Empyema is a condition that causes pus to develop in your pleural space. […] Antibiotics treat most cases of empyema, but a provider may need to drain pus with a needle or through surgery. […] Yes, theres a cure for empyema. Treatment includes removing pus from your pleural space and treating the infection, usually with antibiotics. […] A provider will remove pus through thoracentesis in the early stages of empyema. […] If drainage isnt enough, a provider may try to break up the pus through fibrinolytic therapy. […] In the later stages of empyema, a provider may need to perform a more invasive procedure, such as surgically removing fibrous tissue (decortication), a thoracotomy or a video-assisted thoracic surgery (VATS). […] A healthcare provider will prescribe antibiotics to treat mild cases of empyema.
#1 Empyema and Abscess Pneumonia Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/807499-treatment
Treatment of lung abscesses or empyema is performed in-hospital, with consultations involving internists, pulmonologists, thoracic surgeons, and/or interventional radiologists. […] Once the diagnosis of a lung abscess is made, parenteral antibiotics should be started. Ideally, sputum and blood culture findings should be obtained prior to the initiation of antibiotics. […] After the diagnosis of empyema is made, prompt drainage by means of tube thoracostomy with use of parenteral antibiotics should be initiated. […] Inpatient care is mandatory for the management and assistance of the patient’s respiratory status, continuation of intravenous antibiotics, and drainage of the lung abscess or empyema as needed. Antimicrobial therapy should be continued empirically until therapy can be guided with culture results.
#1 Thoracic Empyema – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK544279/
Empiric broad-spectrum antibiotics are necessary for most patients with suspected or confirmed empyema. […] Antimicrobial therapy should cover methicillin-resistant S aureus, Pseudomonas, and typical organisms and anaerobes. Reasonable options include vancomycin plus metronidazole and an antipseudomonal cephalosporin. […] Chest tube placement under radiologic guidance remains the cornerstone nonsurgical intervention for empyema. […] The use of adjunctive intrapleural therapies has varied outcomes. Isolated fibrinolytic agents such as streptokinase, urokinase, or tissue-type plasminogen activator (tPA) have demonstrated limited benefit. However, combination therapy with tPA and deoxyribonuclease (DNase) significantly improves fluid drainage, reduces surgical referrals, and shortens hospital stays without impacting mortality.
#1 Empyema and Abscess Pneumonia Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/807499-treatment
An empyema is treated with parenteral antibiotics and prompt surgical drainage. Empiric therapy, including anaerobic coverage, for an empyema frequently includes clindamycin, carbapenems, or beta-lactam plus beta-lactamase inhibitors like piperacillin/tazobactam until a definitive organism is identified on pleural fluid cultures and sensitivities are obtained. […] Many clinicians advocate the administration of intrapleural fibrinolytics in patients with empyemas. Intrapleural fibrinolytics assist in the breakdown of fibrin bands that can cause loculation of the empyema and allow for better chest tube drainage of the infected material. […] Complicated parapneumonic effusions or empyemas require drainage in addition to medical therapy to ensure a good prognosis. […] If chest tube or pigtail catheter drainage and fibrinolytic treatment are unsuccessful, many authors recommend video-assisted thoracic surgery (VATS) next rather than the more traditional open thoracotomy. VATS is less invasive and well tolerated, with outcomes that compare favorably with open thoracotomy.
#1 Empyema: Causes, Types, and Symptoms
https://www.healthline.com/health/empyema
Empyema: Causes, Symptoms, and Treatments […] Treatment is aimed at removing the pus and fluid from the pleura and treating the infection. Antibiotics are used to treat the underlying infection. The specific type of antibiotic depends on what type of bacteria is causing the infection. […] The method used to drain the pus depends on the stage of the empyema. […] In simple cases, a needle can be inserted into the pleural space to drain the fluid. This is called percutaneous thoracentesis. […] In the later stages, or complex empyema, a drainage tube must be used to drain the pus. This procedure is usually performed under anesthesia in an operating room. There are different types of surgery for this: […] Thoracostomy: In this procedure, your doctor will insert a plastic tube into your chest between two ribs. Then theyll connect the tube to a suction device and remove the fluid. They may also inject medication to help drain the fluid.
#1 Pleural empyema – Wikipedia
https://en.wikipedia.org/wiki/Pleural_empyema
There is no readily available evidence on the route of administration and duration of antibiotics in patients with pleural empyema. Experts agree that all patients should be hospitalized and treated with antibiotics intravenously. The specific antimicrobial agent should be chosen based on Gram stain and culture, or on local epidemiologic data when these are not available. Anaerobic coverage must be included in all adults, and in children if aspiration is likely. Good pleural fluid and empyema penetration has been reported in adults for penicillins, ceftriaxone, metronidazole, clindamycin, vancomycin, gentamicin and ciprofloxacin. […] There is no clear consensus on duration of intravenous and oral therapy. Switching to oral antibiotics can be considered upon clinical and objective improvement (adequate drainage and removal of chest tube, declining CRP, temperature normalization). Oral antibiotic treatment should then be continued for another 14 weeks, again based on clinical, biochemical and radiological response.
#1 Parapneumonic Pleural Effusions and Empyema Thoracis Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/298485-treatment
Recommendations for the management of pleural infection and empyema have been published by the American Association for Thoracic Surgery (AATS) and the European Respiratory Society (ERS)/European Society for Thoracic Surgery (ESTS). […] The initial treatment of a patient with pneumonia and pleural effusion involves two major decisions. The first decision involves selection of an appropriate antibiotic that will cover likely pathogens; the second involves determination of the need for drainage of pleural fluid. […] The duration of the course of antibiotics depends primarily on the type of effusion, with uncomplicated effusions requiring 1-2 weeks, complicated effusions requiring 2-3 weeks, and empyema requiring 4-6 weeks. […] It is recommended to drain the complicated parapneumonic pleural effusion or empyema thoracis as soon as possible. A delay in removal can lead to the formation of loculated pleural fluid.
#1 Empyema | Diagnosis & Disease Information – Pulmonology Advisor
https://www.pulmonologyadvisor.com/ddi/empyema/
Prompt diagnosis and drainage of pleural space infection are critical in the treatment and management of empyema. […] AATS recommends the following treatment options for patients with pleural empyema: antibiotic treatment, drainage with chest tube or CT-guided catheter, intrapleural fibrinolytic therapy (IPFT), thoracotomy and decortication, and video-assisted thoracoscopic surgery (VATS). […] In general, patients with early-stage empyema are treated with pleural drainage, patients with disease in the fibrinopurulent stage can be treated with IPFT or VATS, and patients with late-stage empyema are treated with decortication. […] Once the diagnosis of empyema is confirmed, tube thoracostomy drainage should be performed promptly. […] In addition to thoracostomy, fibrinolytic agents which induce lysis of fibrin deposits have been used to improve drainage.
#1 Empyema: ED Presentation, Evaluation, and Management – emDocs
https://www.emdocs.net/empyema-ed-presentation-evaluation-and-management/
After initial stabilization of airway, breathing, and circulation, early antibiotic coverage and source control by way of drainage are the next steps. […] In addition to antibiotic coverage, source control via drainage of the empyema is required. This is done by chest tube insertion with the guidance of ultrasound if available. […] After antibiotic administration and chest tube placement, the patient should be admitted to the hospital for continued antibiotic therapy, monitoring of chest tube output and patientâs symptoms. […] Rates of empyema formation may be on the rise, with those admitted for pneumonia and those developing a parapneumonic effusion being at highest risk for developing empyemas. […] Important to obtain pleural fluid samples via thoracentesis for both diagnostic and treatment purposes. […] Source control via drainage by way of chest tube is imperative with some studies suggesting small bore is equivalent to large bore tubes.
#1 Emergent Management of Empyema
https://pmc.ncbi.nlm.nih.gov/articles/PMC3577590/
Empyema is a frankly purulent infection of the pleural space most often occurring secondary to parapneumonic effusion. […] Therapeutic drainage with small-bore tube thoracostomy has been shown to be a safe and effective treatment of early stage empyema. […] Augmentation of tube placement with intrapleural fibrinolytics and mucolytics facilitates catheter drainage by degrading loculations and decreasing fluid viscosity, respectively. […] When an empyema is suspected clinically or radiographically, broad-spectrum antibiotics are typically initiated. Ultimately, sampling of the pleural fluid is required to tailor antibiotic therapy. […] A frankly purulent collection noted on thoracentesis indicates the need for therapeutic drainage. […] Tube thoracostomy with the usage of fibrinolytics is often required because empyema is a fibrinopurulent process characterized by multiloculation.
#1 Empyema and Parapneumonic Effusions: General Considerations | Iowa Head and Neck Protocols
https://medicine.uiowa.edu/iowaprotocols/empyema-and-parapneumonic-effusions-general-considerations
Complications of empyema tend to occur during the chronic stage and may manifest as bronchopleural fistula, intrathoracic abscess, pericarditis, osteomyelitis. […] The optimal duration of therapy is not known. […] Empyema 4-6 weeks. […] The persistence of loculated effusions may depend on their etiology (which bacterial pathogen), appropriateness of antibacterial treatment, and an individual patient’s physiologic and anatomic characteristics. […] Tube thoracostomy works for non-septate collections. […] There is no consensus on the size of chest tube or catheter for drainage, as guidelines vary on their recommendations. […] Timing of tube removal: Output 100 ml/day for clear effusions. 50 ml/day for empyema. […] There is an ongoing debate on the best approach to the management of complicated parapneumonic effusions and empyema.
#1 Parapneumonic Pleural Effusions and Empyema Thoracis Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/298485-treatment
Closed chest tube drainage should be continued as long as clinical and radiologic improvement are observed. […] If the patient does not demonstrate clinical or radiologic improvement with declining pleural fluid drainage, US of the pleural space or CT of the chest should be performed to look for pleural fluid loculations and ensure proper tube placement. […] Since the 1970s, several studies have reported success of thrombolytic therapy for loculated complicated parapneumonic pleural effusions. […] The thrombolytic agents used in parapneumonic pleural effusions were noted to be more effective if administered in the early fibrinopurulent stage of parapneumonic pleural effusions. […] The first MIST (MIST1; N = 454) was a prospective randomized double-blind trial in which patients with pleural infection (either purulent pleural fluid or pleural fluid with a pH 7.20 with signs of infection) received either intrapleural streptokinase (250,000 IU twice daily for 3 days) or placebo, in addition to antibiotics, chest tube drainage, surgery, and other treatment as part of routine care.
#1 Azthena logo with the word Azthena
https://www.news-medical.net/health/Non-Surgical-vs-Surgical-Treatments-for-Empyema.aspx
Empyema often co-occurs with pneumonia and refers to the presence of pus in the pleural space. There is a range of therapeutic options available for the management of empyema, the primary aim being to drain the site of fluid. These treatments can be divided broadly into surgical and non-surgical. […] Non-surgical treatment options include the drainage of pus via the insertion of a tube through the chest wall (thoracostomy drainage), all through the intercostal muscles (intercostal drainage). […] Intrapleural fibrinolysis is an adjunct to treatment. It involves the use of fibrinolytic agents to dissolve fibrinous clots and membranes. […] Surgical treatments are considered in patients that require a prolonged period of thoracostomy; they are considered to be non-responders. […] Surgical treatment involves entry into the site of the empyema via the chest cavity for clearing out the infection (thoracotomy) or camera-assisted incisions on the chest wall, known as videoassisted thoracoscopic surgery (VATS).
#1 Emergent Management of Empyema
https://pmc.ncbi.nlm.nih.gov/articles/PMC3577590/
As mentioned earlier, the use of fibrinolytics is advocated for adjuvant therapy to tube thoracostomy. […] A common regimen includes 10mg of tPA and 5mg DNase injected via the tube thoracostomy twice daily for 3 days. […] In the presence of an advanced stage empyema with multiple loculations and/or thick pleural peel, surgical consultation for video-assisted thorascopic surgery (VATS), decortication, or open thoracotomy should be sought. […] Surgical consultation should be considered in cases when tube thoracostomy with fibrinolytics fails.
#1 Parapneumonic Pleural Effusions and Empyema Thoracis Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/298485-treatment
Antibiotic therapy and drainage constitute the initial management of complicated pleural effusion. In many cases, however, a more aggressive approach is required, involving one of the following: […] Intrapleural enzymatic therapy (IET) – 10 mg of tissue plasminogen activator (TPA) and 5 mg of deoxyribonuclease (DNase) delivered twice a day through the chest tube, left in the pleural cavity for 1 hour, and followed by drainage; this is often initiated and managed by a pulmonary specialist or a thoracic surgeon to monitor clinical response and potential adverse effects. […] Surgery – This often entails a surgical decortication performed by a thoracic surgeon via either an open approach or video-assisted thoracoscopic surgery (VATS); additionally, medical thoracoscopy performed by an interventional pulmonologist has been noted to be a safe and effective minimally invasive endoscopic technique for treating severe pleural infection.
#1 Parapneumonic Pleural Effusions and Empyema Thoracis Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/298485-treatment
The meta-analysis did not support routine use of thrombolytic therapy for all patients who required chest tube drainage for empyema thoracis or complicated parapneumonic pleural effusions. […] The 2023 ERS/ESTS statement made the following recommendations regarding surgical therapy in this setting: Outcomes may be improved when surgical referral and discussion are initiated as early as possible, with the goal of surgical treatment (if found necessary) taking place within 10 days of presentation. […] Surgical intervention is first-line therapy for retained hemothorax and posttraumatic empyema, but medical therapy (eg, IET) may be considered in patients at high operative risk. […] Medical thoracoscopy can be considered as an option for treating multiloculated pleural infection in elderly and frail patients at high operative risk, provided that sufficient local expertise and resources are available.
#1 Management of Empyema – Canadian Association of Thoracic Surgeons
https://www.canadianthoracicsurgeons.ca/2020/09/22/management-of-empyema/
Empyema, or pus in the pleural space, in its various clinical manifestations and stages is a common occurrence that thoracic surgeons are frequently asked to manage. […] The recommendations will focus on reaffirming related definitions, necessary investigations, and appropriate interventions, with specific attention paid to the role of fibrinolytics and indications for surgical intervention (minimally invasive or via thoracotomy). […] There are two primary objectives to treatment of empyema: (1) complete drainage and evacuation of all infected material in the pleural space and (2) liberation of the lung from the exudative peel, therefore allowing full lung expansion. […] Although the use of intrapleural fibrinolysis remains controversial in terms of clear evidence, for those patients who are at higher surgical risk and relatively earlier (Stage 1 and to some degree stage 2) fibrinolytic therapy (tPA and DNase) has been reported to have very good results in well selected patients.
#1 Management of empyema: a comprehensive review – Kanai – Current Challenges in Thoracic Surgery
https://ccts.amegroups.org/article/view/37410/html
Empyema is a state of purulent pleural effusion in the thoracic cavity. The principle of treatment is the administration of appropriate antibiotics and thoracic drainage. If thoracic drainage is insufficient, thoracic surgeons may perform surgical intervention. […] The initial stage of treatment is only antibiotics, and thoracic drainage is performed according to progression. Intrapleural fibrinolytic therapy or surgical treatment is performed when these treatments do not show improvement or there is further progression. […] The usefulness of Intrapleural fibrinolytic therapy has been demonstrated in the MIST2 trial, and a large-scale comparative study of VATS and Intrapleural fibrinolytic therapy is needed in the future. […] Surgical treatment for empyema is indicated when there is no improvement by medical treatment. The usefulness of VATS has been shown in comparison with conventional thoracotomy. Open window thoracotomy has been used as a life-saving measure in postoperative empyema and empyema with bronchial fistula. […] Clinical studies on empyema, such as intrapleural fibrinolytic therapy, have yielded various results. On the other hand, large-scale randomized controlled trials for surgical treatment of empyema have not been conducted, and future research is expected.
#1 Strategy for surgical treatment of acute thoracic empyema in adults – Endoh – Current Challenges in Thoracic Surgery
https://ccts.amegroups.org/article/view/39521/html
Prompt response and initial surgical treatment to empyema could reduce the severity and complications, shorten the hospital stay, and reduce medical costs. […] Treatment of empyema includes administration of antibiotics, thoracic drainage with closed tubing thoracostomy, intrathoracic administration of fibrinolytic agents, and surgery. […] Patients who fail chest tube drainage are also additional candidates for surgical drainage. […] The goals in selecting a surgery are to rapidly establish an effective pleural drainage and to promote lung re-expansion to obliterate the empyema space. […] Surgery is performed mainly for stages II and III and consists of aspiration of pleural effusion, destruction of the fibrin septum in the pleural cavity and single cavitation, removal of purulent pleural effusion and inflammatory substances, adequate pleural lavage, and placement of drainage tubes.
#1 Thoracic Empyema – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK544279/
Surgical consultation should be a consideration when drainage via tube thoracostomy fails or for patients with multiloculated empyema. VATS is a minimally invasive surgical technique that allows for direct visualization and evacuation of the infected pleural space. […] Persistent empyema refractory to standard therapies, including VATS, should be considered for open window thoracostomy with prolonged chest tube drainage or decortication.
#1 Strategy for surgical treatment of acute thoracic empyema in adults – Endoh – Current Challenges in Thoracic Surgery
https://ccts.amegroups.org/article/view/39521/html
This review summarized the surgical management of empyema and treatment strategy by comparing the results of surgical and non-surgical therapies for empyema. […] Treatment for thoracic empyema depends on its stage at diagnosis, and suggested options involve the administration of antibiotics and drainage of pleural effusion. […] In surgical treatment for empyema, drainage and dilatation of the lungs is a basic concept. […] Thoracoscopic decortication, which is currently popular, consists of evacuation by suction, disruption of fibrous pleural septations and peeling off adhesions until the empyema cavity becomes a single space. […] The advantages of thoracoscopic surgery are visualization of the entire thoracic cavity, removal of the purulent pleura, and accurate placement of the thoracic drain with less surgical trauma, improved postoperative pain control, less respiratory compromise and reduction in postoperative complications including 30-day mortality.
#1 Strategy for surgical treatment of acute thoracic empyema in adults – Endoh – Current Challenges in Thoracic Surgery
https://ccts.amegroups.org/article/view/39521/html
Performing drainage promptly during thoracoscopic surgery will help improve results. […] The mortality benefit from intrathoracic administration of fibrinolytic agent for empyema has not been reported; thus further study was needed to explore this effect on mortality. […] These studies demonstrated that the surgery group has higher the initial treatment success rate and mortality rate than the non-surgical treatment group although there was age difference and some degree of selection bias. […] Initial surgical treatment had significantly better outcomes in primary treatment success rate and length of hospital stay than non-surgical treatment in stage II/III empyema. […] Compared with OT, VATS for stage II/III empyema could reduce the operative time and length of hospital stay without compromising the primary treatment success rate and complications and mortality after surgery.
#1
https://journals.lww.com/ascp/fulltext/2019/07020/management_of_parapneumonic_effusion_and_empyema.1.aspx
The management of parapneumonic effusions and empyemas involves the following: Appropriate antibiotic, Management of the pleural fluid. All patients with parapneumonic effusions or empyema should be treated with antibiotics. The Gram stain of the pleural fluid should guide the selection of an antibiotic. […] The options available for the management of the pleural fluid in patients with parapneumonic effusion are as follows: Conservative, Therapeutic thoracentesis, Intercostal chest tube drainage, Intrapleural fibrinolysis, VATS, Thoracotomy with decortication and the breakdown of adhesions, and open drainage. […] Intrapleural fibrinolytics destroy the fibrin membranes and facilitate drainage of the pleural fluid. […] Video-assisted thoracoscopic surgery (VATS) is often used to debride multiloculated empyemas or uniloculated empyemas that fail to resolve with antibiotics and chest tube drainage. […] Decortication involves removal of all the fibrous tissue from the visceral and parietal pleura along with pus from the pleural space. It eliminates the pleural sepsis and thus assists expansion of underlying lung.
#1 Empyema: Causes, Types, and Symptoms
https://www.healthline.com/health/empyema
Video-assisted thoracic surgery: Your surgeon will remove the affected tissue around your lung and then insert a drainage tube or use medication to remove the fluid. They will create three small incisions and use a tiny camera called a thoracoscope for this process. […] Open decortication: In this surgery, your surgeon will peel away the pleural peel. […] The outlook for empyema with prompt treatment is good. Long-term damage to the lungs is rare. You should finish your prescribed antibiotics and go in for a follow-up chest X-ray. Your doctor can make sure your pleura has healed properly. […] However, in people with other conditions that compromise the immune system, empyema can have a mortality rate as high as 40 percent. […] If its not treated, empyema can lead to potentially life-threatening complications such as sepsis.
#1 Empyema and Parapneumonic Effusions: Thoracoscopic (VATS) Drainage and Decortication | Iowa Head and Neck Protocols
https://medicine.uiowa.edu/iowaprotocols/empyema-and-parapneumonic-effusions-thoracoscopic-vats-drainage-and-decortication
Late stages of empyema and fibrothorax require thoracotomy to release trapped lung. […] Decortication is performed to remove adherent fibropurulent exudate or fibrotic rind covering the mobilized lung surfaces. Maximally possible decortication should be performed to expand the lung. […] If the thoracoscopic approach is not feasible to perform complete decortication then convert to thoracotomy.
#1 Azthena logo with the word Azthena
https://www.news-medical.net/health/Non-Surgical-vs-Surgical-Treatments-for-Empyema.aspx
Risks from both forms of surgical intervention include pain in the ribs, called intercostal neuralgia, positive pneumothorax, and anesthetic complications. Longer recovery periods are generally needed with surgical interventions; however, VATS is more commonly performed as the recovery period for this form of surgery is lower relative to open thoracotomy. […] Overall, the authors concluded no statistical significance in mortality between surgical and non-surgical interventions for empyema for all age groups.
#1 Management of Empyema – Canadian Association of Thoracic Surgeons
https://www.canadianthoracicsurgeons.ca/2020/09/22/management-of-empyema/
Surgical management with or decortication is the most definitive means of treating empyema of all stages. […] If complete evacuation of infected material and lung expansion can not be achieved by less invasive means, then surgical management is indicated. […] There is a role for thoracoscopy in the management of empyema. […] If the infected material cannot be removed or the lung can not be re-expanded completely, then conversion to thoracotomy is encouraged in order to achieve these two objectives. […] Finally, if it is impossible to evacuate the pleural space of all infected material or lung expansion can not be achieved with a decortication, then one must consider prolonged drainage.
#1 Empyema and Parapneumonic Effusions: General Considerations | Iowa Head and Neck Protocols
https://medicine.uiowa.edu/iowaprotocols/empyema-and-parapneumonic-effusions-general-considerations
Three phases of empyema are classically described: […] The exudative phase (Stage I) occurs during first 1-2 weeks of illness when the fluid is free-floating within the thorax and associated with inflamed pleura. Simple drainage with chest tube and intravenous antibiotics are usually sufficient for management. […] The fibropurulent phase (Stage II) during weeks 1-4 is characterized by purulent effusion and fibrinous exudative deposits on the pleural surface. […] At this point tube drainage alone is not effective. This stage requires removal of the fibropurulent debris and drain infected fluid. […] The fibrous phase (Stage III) is best avoided by NOT DELAYING drainage during the earlier stages. […] A thoracotomy and open decortication are usually required to achieve a complete decortication and reexpand the lung.
#1 Treatment Of Pleural Empyema By Video-Assisted Thoracic Surgery In Pat | MDER
https://www.dovepress.com/outcome-of-pleural-empyema-treated-with-video-assisted-thoracoscopic-s-peer-reviewed-fulltext-article-MDER
Empyema patients with poor physical condition and severe comorbidities face a significant challenge, with difficulties in choosing appropriate treatment methods, limited treatment outcomes, and a high rate of complications and mortality. […] To comment on the indications and to evaluate the treatment outcomes of pleural empyema in patients with poor physical condition and severe comorbidities by thoracoscopic surgery. […] The surgery procedures were efficient with a short duration (65.6 9.4 minutes), low incidence of blood transfusion (8.3%), and lower rate of postoperative complications (surgical wound infection 8.3%). […] Video-Assisted Thoracoscopic Surgery (VATS) exhibits positive outcomes in treating stage I and II pleural empyema patients who incurred severe comorbidities. […] Treatment of patients with empyema in poor health conditions and severe comorbidities remains a challenge.
#1 Treatment Of Pleural Empyema By Video-Assisted Thoracic Surgery In Pat | MDER
https://www.dovepress.com/outcome-of-pleural-empyema-treated-with-video-assisted-thoracoscopic-s-peer-reviewed-fulltext-article-MDER
The limited success in the use of current methods raises the need for further research to improve the effectiveness of treatment approaches. […] Despite various interventions, the treatment of pleural empyema in patients with poor physical condition and severe comorbidities is still challenging. […] The application of VATS to clean the pleural cavity combined with tube gradually withdrawn to treat sub-acute and acute stages of empyema in patients with severe combined diseases has yielded positive results. The approach has shown a high recovery rate, safety and mild complications with a low frequency (8.3%).
#1 Pleural empyema
https://www.pch.health.wa.gov.au/For-health-professionals/Clinical-Practice-Guidelines/Pleural-empyema
This guideline provides a clinical framework for the assessment, investigation and management of children and adolescents presenting to PCH with a pleural empyema. […] There is no agreed standard treatment regimen for childhood empyema. […] Current literature suggests that there is no significant difference in outcomes between chest drain with intrapleural fibrinolytics or VATS. […] Chest drain and intrapleural fibrinolytics may offer the same clinical benefit but at a lower cost. […] The course of treatment depends on several factors including the child’s respiratory function, size and loculation of the fluid collection, as well as the response to initial interventions. […] Empiric intravenous antibiotics are the first line of treatment. […] If there is a moderate-large collection seen on ultrasound, chest drain insertion and intrapleural-fibrinolytic installation should be considered in conjunction with antibiotics.
#1 Pleural empyema
https://www.pch.health.wa.gov.au/For-health-professionals/Clinical-Practice-Guidelines/Pleural-empyema
VATS should be reserved for failure of conservative management. […] Surgical interventions include VATS, mini-thoracotomy or open decortication. […] There is some evidence that primary VATS may reduce hospital length of stay in some patients, however any invasive procedure should be reserved for failure of conservative management. […] At PCH, chest drain plus fibrinolysis is the preferred option for children/adolescents with a pleural empyema requiring drainage, unless specific circumstances dictate otherwise. […] Intrapleural interventions have been associated with significantly shorter hospital stays compared with intravenous antibiotics alone, while instillation of intrapleural fibrinolytics offers benefit beyond simple chest tube drainage in shortening length of hospital stay. […] Intrapleural Alteplase (tissue type plasminogen activator, tPA) should be instilled from the outset if the pleural fluid obtained is turbid or if there is evidence of loculations on ultrasound.
#1 Paediatric complicated pneumonia: Diagnosis and management of empyema | Canadian Paediatric Society
https://cps.ca/documents/position/complicated-pneumonia-empyema
Antibiotics remain a key component in the medical management of empyema, with initial parenteral therapy to cover the most common pathogens, usually followed by oral therapy. […] A variety of procedural interventions are used in Canada for the management of empyema. These include chest tube placement with or without fibrinolytics, repeated thoracentesis, video-assisted thorascopic surgery (VATS) and open thoracotomy with decortication. Best evidence based on only a few randomized trial suggests that either early small-bore percutaneous chest tube placement with instillation of fibrinolytics (CTWF) or early VATS leads to best outcome as measured by hospital length of stay. […] In Canada, tissue plasminogen activator is the fibrinolytic commonly used (at a dose of 4 mg in 30 mL to 50 mL of normal saline daily for up to three days). Intrapleural dornase alfa, while effective in adults with empyema, provides no additional benefit in children.
#1 Management of patient with Fusobacterim nucletum related pleural empyema: intrapleural antibiotic therapy can be considered for salvage therapy | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09582-9
Pleural empyema can lead to significant morbidity and mortality despite chest drainage and antibiotic treatment, necessitating novel and minimally invasive interventions. […] Ultimately, successful treatment was achieved through intrapleural metronidazole therapy in conjunction with systemic antibiotics. The present case showed that intrapleural antibiotic therapy is a promising measure for pleural empyema. […] Therefore, there is a need for new minimally invasive treatment methods. This article presents a case of multiple intrapleural antibiotic therapy under CT guidance in a patient with primary pleural infection. […] Intrathoracic local administration increases local tissue drug concentrations. As an adjunct to intravenous anti-infective therapy, intrathoracic antibiotic injection improves bacterial clearance and promotes absorption in the abscessed chest.
#1 Management of patient with Fusobacterim nucletum related pleural empyema: intrapleural antibiotic therapy can be considered for salvage therapy | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09582-9
Although there is limited evidence on intrapleural antibiotics, mainly consisting of case reports or case series, the encouraging outcomes indicate that intrapleural antibiotics hold promise for future research. Pleural injection can be suggested when thoracocentesis with systemic antiobiotherapy have failed and when surgery cant be performed because of comorbidities or because of patient refusal.
#1 Empyema: Causes, Symptoms, Diagnosis, and Treatment Options
https://www.metropolisindia.com/blog/preventive-healthcare/empyema-understanding-pus-in-the-pleural-space-and-treatment-options
Empyema can be cured with prompt and appropriate treatment. The goals of treatment are to drain the infected fluid, eliminate the underlying infection, and allow the lung to re-expand. […] Treatment for empyema typically involves antibiotics to clear the infection. Broad-spectrum antibiotics are started initially and then tailored to target the specific bacteria found in the pleural fluid. […] Many people start to feel better within a few days of starting empyema treatment. Chest pain and shortness of breath often improve once the infected fluid is drained. Fatigue and cough may linger for a few weeks. Most people are able to return to their normal activities after 2-4 weeks, but complete recovery can take several months.
#1 Indian Pediatrics – Editorial
https://www.indianpediatrics.net/feb2002/feb-145-157.htm
Effective therapy requires control of infection, drainage of pus and expansion of lungs. […] Antibiotic coverage should be given in all cases of empyema depending on suspected etiological agent. […] Empyema drainage is a major component of empyema treatment. Patients with loculated fluid, or frank pus, or smear positive fluid, or fluid with pH less than 7.10, glucose less than 40 mg/dl and LDH more than 1000 IU/L, require chest tube drainage. […] This is useful in multiloculated empyema. […] Videoassisted Thoracoscopic Surgery (VATS) is quite effective in lysis of adhesions in multiloculated effusions and removal of fibrinous material from pleural cavity. […] Thoracoscopic Debridement and Irrigation is quite effective in cases with multiloculated empyema. […] Decortication is advised for the cases not helped by above procedures.
#1 Methods of treatment of pleural empyema in children
https://www.termedia.pl/Methods-of-treatment-of-pleural-empyema-in-children,127,37122,1,1.html
In 1918, Graham et al. established the principles of treatment of pleural empyema, which assumed the following: decompression of accumulated purulent content from the pleural cavity, efforts to early sterilise and overgrow the empyema cavity and improve the patients nutritional status. They remain unaltered. A significant improvement in the treatment of pulmonary infections and pleural empyema was caused by the introduction of antibiotic therapy in the 1940s. Currently, the three main principles of pleural empyema treatment are: evacuation of exudate from the pleural cavity, targeted antibiotic therapy, supportive treatment (physiotherapy, nutritional treatment, etc.). In most cases of pleural empyema antibiotic therapy starts as empirical with broad-spectrum antibiotics. Penicillin combined with -lactamase inhibitors and third-generation cephalosporins are most commonly used because of their good penetration of the pleural space. In the case of reasonable suspicion of infection caused by atypical pathogens, macrolide antibiotics are indicated. When suspected of methicillin-resistant Staphylococcus aureus infections, vancomycin or linezolid is required. Broad-spectrum antibiotic therapy is continued until the presence of bacteria in pleural fluid or blood is confirmed and their sensitivity to antibiotics is determined, then targeted antibiotic therapy is administered. Debridement of the pleural cavity from purulent content, in addition to removing the infectious agent, results in lung expansion and improvement of lung ventilation. This significantly influences on the shortening of the treatment time of the pulmonary-pleural infection, improves the general health condition, and allows quick recovery of the patient. Techniques of decompression of the pleural cavity are: thoracentesis, pleural cavity drainage, and thoracoscopy.
#1 Paediatric complicated pneumonia: Diagnosis and management of empyema | Canadian Paediatric Society
https://cps.ca/documents/position/complicated-pneumonia-empyema
Pneumonia can be complicated by an empyema, progressing from an exudative effusion, to a fibrinopurulent stage with loculations, and then organized with a thick fibrinous peel. […] Additional invasive or surgical management is recommended to reduce the duration of illness in cases not promptly responding to antibiotics or with significant respiratory compromise. Cost-effectiveness evidence supports the insertion of a small-bore percutaneous chest tube with instillation of fibrinolytics as the first-line intervention. Video-assisted thorascopic surgery offers similar clinical effectiveness. […] Early initiation of antibiotics either alone or together with a drainage procedure is recommended for all patients. Early procedural intervention is recommended if the patient is in moderate to severe respiratory distress (worsening tachypnea, work of breathing and/or hypoxia) because the pleural fluid often occupies most of the hemithorax and may even cause mediastinal shift.
#1
https://journals.lww.com/ascp/fulltext/2019/07020/management_of_parapneumonic_effusion_and_empyema.1.aspx
Parapneumonic effusions are pleural effusions that occur in the pleural space adjacent to a bacterial pneumonia. When bacteria invade the pleural space, a complicated parapneumonic effusion or empyema may result. Empyema is collection of pus in pleural cavity. If left untreated, complicated parapneumonic effusion/empyema leads to chronic encasement and pleural thickening. Simple parapneumonic effusions can be managed conservatively with appropriate antibiotics, but complicated parapneumonic effusions often require some kind of drainage along with antibiotics. Delay in treatment is associated with high morbidity and mortality. Management includes well-selected antibiotics and drainage by tube thoracostomy. Intrapleural fibrinolytics have been used in multiloculated complicated parapneumonic effusions with success.
#2 Empyema | Diagnosis & Disease Information – Pulmonology Advisor
https://www.pulmonologyadvisor.com/ddi/empyema/
Prompt diagnosis and drainage of pleural space infection are critical in the treatment and management of empyema. […] AATS recommends the following treatment options for patients with pleural empyema: antibiotic treatment, drainage with chest tube or CT-guided catheter, intrapleural fibrinolytic therapy (IPFT), thoracotomy and decortication, and video-assisted thoracoscopic surgery (VATS). […] In general, patients with early-stage empyema are treated with pleural drainage, patients with disease in the fibrinopurulent stage can be treated with IPFT or VATS, and patients with late-stage empyema are treated with decortication. […] Once the diagnosis of empyema is confirmed, tube thoracostomy drainage should be performed promptly. […] In addition to thoracostomy, fibrinolytic agents which induce lysis of fibrin deposits have been used to improve drainage.
#2 Empyema: ED Presentation, Evaluation, and Management – emDocs
https://www.emdocs.net/empyema-ed-presentation-evaluation-and-management/
After initial stabilization of airway, breathing, and circulation, early antibiotic coverage and source control by way of drainage are the next steps. […] In addition to antibiotic coverage, source control via drainage of the empyema is required. This is done by chest tube insertion with the guidance of ultrasound if available. […] After antibiotic administration and chest tube placement, the patient should be admitted to the hospital for continued antibiotic therapy, monitoring of chest tube output and patientâs symptoms. […] Rates of empyema formation may be on the rise, with those admitted for pneumonia and those developing a parapneumonic effusion being at highest risk for developing empyemas. […] Important to obtain pleural fluid samples via thoracentesis for both diagnostic and treatment purposes. […] Source control via drainage by way of chest tube is imperative with some studies suggesting small bore is equivalent to large bore tubes.
#2 Thoracic Empyema – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK544279/
Empiric broad-spectrum antibiotics are necessary for most patients with suspected or confirmed empyema. […] Antimicrobial therapy should cover methicillin-resistant S aureus, Pseudomonas, and typical organisms and anaerobes. Reasonable options include vancomycin plus metronidazole and an antipseudomonal cephalosporin. […] Chest tube placement under radiologic guidance remains the cornerstone nonsurgical intervention for empyema. […] The use of adjunctive intrapleural therapies has varied outcomes. Isolated fibrinolytic agents such as streptokinase, urokinase, or tissue-type plasminogen activator (tPA) have demonstrated limited benefit. However, combination therapy with tPA and deoxyribonuclease (DNase) significantly improves fluid drainage, reduces surgical referrals, and shortens hospital stays without impacting mortality.
#2 Empyema: Causes, Symptoms, Diagnosis & Treatment
https://my.clevelandclinic.org/health/diseases/24269-empyema
Antibiotics typically take two to six weeks to work. […] If a provider prescribes antibiotics to treat empyema, its important to take your full course of antibiotics, even if you feel better. […] The best way to prevent empyema is to treat any lung infections quickly. […] Empyema can be fatal if you dont receive treatment or have other conditions.
#2 Management and prognosis of parapneumonic pleural effusion and empyema in adults – UpToDate
https://www.uptodate.com/contents/management-and-prognosis-of-parapneumonic-pleural-effusion-and-empyema-in-adults
A parapneumonic effusion is a pleural effusion that forms in the pleural space adjacent to a pneumonia. When microorganisms infect the pleural space, a complicated parapneumonic effusion or empyema may result. Prompt therapy of these entities can be lifesaving. […] The treatment and prognosis of parapneumonic effusion and empyema are reviewed here. […] A complicated parapneumonic effusion refers to an effusion that has been infected with bacteria or other microorganisms (eg, positive Gram stain or biochemical evidence of marked inflammation).
#2 Empyema: Causes, Symptoms, Diagnosis & Treatment
https://my.clevelandclinic.org/health/diseases/24269-empyema
Empyema is a condition that causes pus to develop in your pleural space. […] Antibiotics treat most cases of empyema, but a provider may need to drain pus with a needle or through surgery. […] Yes, theres a cure for empyema. Treatment includes removing pus from your pleural space and treating the infection, usually with antibiotics. […] A provider will remove pus through thoracentesis in the early stages of empyema. […] If drainage isnt enough, a provider may try to break up the pus through fibrinolytic therapy. […] In the later stages of empyema, a provider may need to perform a more invasive procedure, such as surgically removing fibrous tissue (decortication), a thoracotomy or a video-assisted thoracic surgery (VATS). […] A healthcare provider will prescribe antibiotics to treat mild cases of empyema.
#2 Emergent Management of Empyema
https://pmc.ncbi.nlm.nih.gov/articles/PMC3577590/
Empyema is a frankly purulent infection of the pleural space most often occurring secondary to parapneumonic effusion. […] Therapeutic drainage with small-bore tube thoracostomy has been shown to be a safe and effective treatment of early stage empyema. […] Augmentation of tube placement with intrapleural fibrinolytics and mucolytics facilitates catheter drainage by degrading loculations and decreasing fluid viscosity, respectively. […] When an empyema is suspected clinically or radiographically, broad-spectrum antibiotics are typically initiated. Ultimately, sampling of the pleural fluid is required to tailor antibiotic therapy. […] A frankly purulent collection noted on thoracentesis indicates the need for therapeutic drainage. […] Tube thoracostomy with the usage of fibrinolytics is often required because empyema is a fibrinopurulent process characterized by multiloculation.
#2 Parapneumonic Pleural Effusions and Empyema Thoracis Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/298485-treatment
Closed chest tube drainage should be continued as long as clinical and radiologic improvement are observed. […] If the patient does not demonstrate clinical or radiologic improvement with declining pleural fluid drainage, US of the pleural space or CT of the chest should be performed to look for pleural fluid loculations and ensure proper tube placement. […] Since the 1970s, several studies have reported success of thrombolytic therapy for loculated complicated parapneumonic pleural effusions. […] The thrombolytic agents used in parapneumonic pleural effusions were noted to be more effective if administered in the early fibrinopurulent stage of parapneumonic pleural effusions. […] The first MIST (MIST1; N = 454) was a prospective randomized double-blind trial in which patients with pleural infection (either purulent pleural fluid or pleural fluid with a pH 7.20 with signs of infection) received either intrapleural streptokinase (250,000 IU twice daily for 3 days) or placebo, in addition to antibiotics, chest tube drainage, surgery, and other treatment as part of routine care.
#2 Empyema and Parapneumonic Effusions: General Considerations | Iowa Head and Neck Protocols
https://medicine.uiowa.edu/iowaprotocols/empyema-and-parapneumonic-effusions-general-considerations
Complications of empyema tend to occur during the chronic stage and may manifest as bronchopleural fistula, intrathoracic abscess, pericarditis, osteomyelitis. […] The optimal duration of therapy is not known. […] Empyema 4-6 weeks. […] The persistence of loculated effusions may depend on their etiology (which bacterial pathogen), appropriateness of antibacterial treatment, and an individual patient’s physiologic and anatomic characteristics. […] Tube thoracostomy works for non-septate collections. […] There is no consensus on the size of chest tube or catheter for drainage, as guidelines vary on their recommendations. […] Timing of tube removal: Output 100 ml/day for clear effusions. 50 ml/day for empyema. […] There is an ongoing debate on the best approach to the management of complicated parapneumonic effusions and empyema.
#2 Strategy for surgical treatment of acute thoracic empyema in adults – Endoh – Current Challenges in Thoracic Surgery
https://ccts.amegroups.org/article/view/39521/html
This review summarized the surgical management of empyema and treatment strategy by comparing the results of surgical and non-surgical therapies for empyema. […] Treatment for thoracic empyema depends on its stage at diagnosis, and suggested options involve the administration of antibiotics and drainage of pleural effusion. […] In surgical treatment for empyema, drainage and dilatation of the lungs is a basic concept. […] Thoracoscopic decortication, which is currently popular, consists of evacuation by suction, disruption of fibrous pleural septations and peeling off adhesions until the empyema cavity becomes a single space. […] The advantages of thoracoscopic surgery are visualization of the entire thoracic cavity, removal of the purulent pleura, and accurate placement of the thoracic drain with less surgical trauma, improved postoperative pain control, less respiratory compromise and reduction in postoperative complications including 30-day mortality.
#2
https://journals.lww.com/ascp/fulltext/2019/07020/management_of_parapneumonic_effusion_and_empyema.1.aspx
The management of parapneumonic effusions and empyemas involves the following: Appropriate antibiotic, Management of the pleural fluid. All patients with parapneumonic effusions or empyema should be treated with antibiotics. The Gram stain of the pleural fluid should guide the selection of an antibiotic. […] The options available for the management of the pleural fluid in patients with parapneumonic effusion are as follows: Conservative, Therapeutic thoracentesis, Intercostal chest tube drainage, Intrapleural fibrinolysis, VATS, Thoracotomy with decortication and the breakdown of adhesions, and open drainage. […] Intrapleural fibrinolytics destroy the fibrin membranes and facilitate drainage of the pleural fluid. […] Video-assisted thoracoscopic surgery (VATS) is often used to debride multiloculated empyemas or uniloculated empyemas that fail to resolve with antibiotics and chest tube drainage. […] Decortication involves removal of all the fibrous tissue from the visceral and parietal pleura along with pus from the pleural space. It eliminates the pleural sepsis and thus assists expansion of underlying lung.
#2 Empyema and Parapneumonic Effusions: General Considerations | Iowa Head and Neck Protocols
https://medicine.uiowa.edu/iowaprotocols/empyema-and-parapneumonic-effusions-general-considerations
Three phases of empyema are classically described: […] The exudative phase (Stage I) occurs during first 1-2 weeks of illness when the fluid is free-floating within the thorax and associated with inflamed pleura. Simple drainage with chest tube and intravenous antibiotics are usually sufficient for management. […] The fibropurulent phase (Stage II) during weeks 1-4 is characterized by purulent effusion and fibrinous exudative deposits on the pleural surface. […] At this point tube drainage alone is not effective. This stage requires removal of the fibropurulent debris and drain infected fluid. […] The fibrous phase (Stage III) is best avoided by NOT DELAYING drainage during the earlier stages. […] A thoracotomy and open decortication are usually required to achieve a complete decortication and reexpand the lung.
#2 Treatment Of Pleural Empyema By Video-Assisted Thoracic Surgery In Pat | MDER
https://www.dovepress.com/outcome-of-pleural-empyema-treated-with-video-assisted-thoracoscopic-s-peer-reviewed-fulltext-article-MDER
The limited success in the use of current methods raises the need for further research to improve the effectiveness of treatment approaches. […] Despite various interventions, the treatment of pleural empyema in patients with poor physical condition and severe comorbidities is still challenging. […] The application of VATS to clean the pleural cavity combined with tube gradually withdrawn to treat sub-acute and acute stages of empyema in patients with severe combined diseases has yielded positive results. The approach has shown a high recovery rate, safety and mild complications with a low frequency (8.3%).
#2 Pleural empyema
https://www.pch.health.wa.gov.au/For-health-professionals/Clinical-Practice-Guidelines/Pleural-empyema
This guideline provides a clinical framework for the assessment, investigation and management of children and adolescents presenting to PCH with a pleural empyema. […] There is no agreed standard treatment regimen for childhood empyema. […] Current literature suggests that there is no significant difference in outcomes between chest drain with intrapleural fibrinolytics or VATS. […] Chest drain and intrapleural fibrinolytics may offer the same clinical benefit but at a lower cost. […] The course of treatment depends on several factors including the child’s respiratory function, size and loculation of the fluid collection, as well as the response to initial interventions. […] Empiric intravenous antibiotics are the first line of treatment. […] If there is a moderate-large collection seen on ultrasound, chest drain insertion and intrapleural-fibrinolytic installation should be considered in conjunction with antibiotics.
#2 Pleural empyema
https://www.pch.health.wa.gov.au/For-health-professionals/Clinical-Practice-Guidelines/Pleural-empyema
VATS should be reserved for failure of conservative management. […] Surgical interventions include VATS, mini-thoracotomy or open decortication. […] There is some evidence that primary VATS may reduce hospital length of stay in some patients, however any invasive procedure should be reserved for failure of conservative management. […] At PCH, chest drain plus fibrinolysis is the preferred option for children/adolescents with a pleural empyema requiring drainage, unless specific circumstances dictate otherwise. […] Intrapleural interventions have been associated with significantly shorter hospital stays compared with intravenous antibiotics alone, while instillation of intrapleural fibrinolytics offers benefit beyond simple chest tube drainage in shortening length of hospital stay. […] Intrapleural Alteplase (tissue type plasminogen activator, tPA) should be instilled from the outset if the pleural fluid obtained is turbid or if there is evidence of loculations on ultrasound.
#2 Management of patient with Fusobacterim nucletum related pleural empyema: intrapleural antibiotic therapy can be considered for salvage therapy | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09582-9
Pleural empyema can lead to significant morbidity and mortality despite chest drainage and antibiotic treatment, necessitating novel and minimally invasive interventions. […] Ultimately, successful treatment was achieved through intrapleural metronidazole therapy in conjunction with systemic antibiotics. The present case showed that intrapleural antibiotic therapy is a promising measure for pleural empyema. […] Therefore, there is a need for new minimally invasive treatment methods. This article presents a case of multiple intrapleural antibiotic therapy under CT guidance in a patient with primary pleural infection. […] Intrathoracic local administration increases local tissue drug concentrations. As an adjunct to intravenous anti-infective therapy, intrathoracic antibiotic injection improves bacterial clearance and promotes absorption in the abscessed chest.
#2 Management of patient with Fusobacterim nucletum related pleural empyema: intrapleural antibiotic therapy can be considered for salvage therapy | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09582-9
Although there is limited evidence on intrapleural antibiotics, mainly consisting of case reports or case series, the encouraging outcomes indicate that intrapleural antibiotics hold promise for future research. Pleural injection can be suggested when thoracocentesis with systemic antiobiotherapy have failed and when surgery cant be performed because of comorbidities or because of patient refusal.
#2 Empyema: Causes, Types, and Symptoms
https://www.healthline.com/health/empyema
Video-assisted thoracic surgery: Your surgeon will remove the affected tissue around your lung and then insert a drainage tube or use medication to remove the fluid. They will create three small incisions and use a tiny camera called a thoracoscope for this process. […] Open decortication: In this surgery, your surgeon will peel away the pleural peel. […] The outlook for empyema with prompt treatment is good. Long-term damage to the lungs is rare. You should finish your prescribed antibiotics and go in for a follow-up chest X-ray. Your doctor can make sure your pleura has healed properly. […] However, in people with other conditions that compromise the immune system, empyema can have a mortality rate as high as 40 percent. […] If its not treated, empyema can lead to potentially life-threatening complications such as sepsis.
#2 Paediatric complicated pneumonia: Diagnosis and management of empyema | Canadian Paediatric Society
https://cps.ca/documents/position/complicated-pneumonia-empyema
Pneumonia can be complicated by an empyema, progressing from an exudative effusion, to a fibrinopurulent stage with loculations, and then organized with a thick fibrinous peel. […] Additional invasive or surgical management is recommended to reduce the duration of illness in cases not promptly responding to antibiotics or with significant respiratory compromise. Cost-effectiveness evidence supports the insertion of a small-bore percutaneous chest tube with instillation of fibrinolytics as the first-line intervention. Video-assisted thorascopic surgery offers similar clinical effectiveness. […] Early initiation of antibiotics either alone or together with a drainage procedure is recommended for all patients. Early procedural intervention is recommended if the patient is in moderate to severe respiratory distress (worsening tachypnea, work of breathing and/or hypoxia) because the pleural fluid often occupies most of the hemithorax and may even cause mediastinal shift.
#3 Thoracic Empyema – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK544279/
Thoracic empyema, characterized by the presence of purulent fluid in the pleural space, remains a significant clinical challenge with considerable morbidity and mortality. Early diagnosis and aggressive management, including antimicrobial therapy, drainage procedures, and sometimes surgery, are critical for favorable outcomes. […] The integration of evidence-based practices, including the role of intrapleural enzyme therapy, surgical interventions, and antimicrobial stewardship, is emphasized to equip clinicians better to deliver timely and effective care and reduce the burden of this challenging condition. […] The treatment and management of thoracic empyema involve a combination of medical and surgical interventions aimed at eradicating infection, achieving adequate drainage of the pleural space, and restoring lung function. Early and aggressive management is critical to improving outcomes and minimizing complications. […] Management aims to eradicate infection through antimicrobials and achieve adequate pleural drainage using tube thoracostomy, with or without intrapleural therapies, video-assisted thoracoscopic surgery (VATS), or open thoracotomy with decortication.
#3 Pleural empyema
https://www.pch.health.wa.gov.au/For-health-professionals/Clinical-Practice-Guidelines/Pleural-empyema
This guideline provides a clinical framework for the assessment, investigation and management of children and adolescents presenting to PCH with a pleural empyema. […] There is no agreed standard treatment regimen for childhood empyema. […] Current literature suggests that there is no significant difference in outcomes between chest drain with intrapleural fibrinolytics or VATS. […] Chest drain and intrapleural fibrinolytics may offer the same clinical benefit but at a lower cost. […] The course of treatment depends on several factors including the child’s respiratory function, size and loculation of the fluid collection, as well as the response to initial interventions. […] Empiric intravenous antibiotics are the first line of treatment. […] If there is a moderate-large collection seen on ultrasound, chest drain insertion and intrapleural-fibrinolytic installation should be considered in conjunction with antibiotics.
#3 Empyema: Causes, Types, and Symptoms
https://www.healthline.com/health/empyema
Video-assisted thoracic surgery: Your surgeon will remove the affected tissue around your lung and then insert a drainage tube or use medication to remove the fluid. They will create three small incisions and use a tiny camera called a thoracoscope for this process. […] Open decortication: In this surgery, your surgeon will peel away the pleural peel. […] The outlook for empyema with prompt treatment is good. Long-term damage to the lungs is rare. You should finish your prescribed antibiotics and go in for a follow-up chest X-ray. Your doctor can make sure your pleura has healed properly. […] However, in people with other conditions that compromise the immune system, empyema can have a mortality rate as high as 40 percent. […] If its not treated, empyema can lead to potentially life-threatening complications such as sepsis.
#4 Empyema | Diagnosis & Disease Information – Pulmonology Advisor
https://www.pulmonologyadvisor.com/ddi/empyema/
Prompt diagnosis and drainage of pleural space infection are critical in the treatment and management of empyema. […] AATS recommends the following treatment options for patients with pleural empyema: antibiotic treatment, drainage with chest tube or CT-guided catheter, intrapleural fibrinolytic therapy (IPFT), thoracotomy and decortication, and video-assisted thoracoscopic surgery (VATS). […] In general, patients with early-stage empyema are treated with pleural drainage, patients with disease in the fibrinopurulent stage can be treated with IPFT or VATS, and patients with late-stage empyema are treated with decortication. […] Once the diagnosis of empyema is confirmed, tube thoracostomy drainage should be performed promptly. […] In addition to thoracostomy, fibrinolytic agents which induce lysis of fibrin deposits have been used to improve drainage.
#4 Empyema: Causes, Types, and Symptoms
https://www.healthline.com/health/empyema
Video-assisted thoracic surgery: Your surgeon will remove the affected tissue around your lung and then insert a drainage tube or use medication to remove the fluid. They will create three small incisions and use a tiny camera called a thoracoscope for this process. […] Open decortication: In this surgery, your surgeon will peel away the pleural peel. […] The outlook for empyema with prompt treatment is good. Long-term damage to the lungs is rare. You should finish your prescribed antibiotics and go in for a follow-up chest X-ray. Your doctor can make sure your pleura has healed properly. […] However, in people with other conditions that compromise the immune system, empyema can have a mortality rate as high as 40 percent. […] If its not treated, empyema can lead to potentially life-threatening complications such as sepsis.
#5 Empyema | Diagnosis & Disease Information – Pulmonology Advisor
https://www.pulmonologyadvisor.com/ddi/empyema/
Prompt diagnosis and drainage of pleural space infection are critical in the treatment and management of empyema. […] AATS recommends the following treatment options for patients with pleural empyema: antibiotic treatment, drainage with chest tube or CT-guided catheter, intrapleural fibrinolytic therapy (IPFT), thoracotomy and decortication, and video-assisted thoracoscopic surgery (VATS). […] In general, patients with early-stage empyema are treated with pleural drainage, patients with disease in the fibrinopurulent stage can be treated with IPFT or VATS, and patients with late-stage empyema are treated with decortication. […] Once the diagnosis of empyema is confirmed, tube thoracostomy drainage should be performed promptly. […] In addition to thoracostomy, fibrinolytic agents which induce lysis of fibrin deposits have been used to improve drainage.