Management of Complicated Empyema with Thoracic Window and Negative Pressure System

ABSTRACT

Introduction: the thoracic empyema is defined as a purulent pleural effusion. Its most frequent cause is infectious parapneumonic effusion; however, postsurgical or posttraumatic empyema can also occur. The empyema has a progressive three-phase evolution and its treatment shall focus on the cause of the disease, the evolutionary phase and the general condition of the patient. In order to cure this condition, some cases require thoracotomy with open thoracic window drainage. Materials and Method: observational, retrospective and descriptive study based on a series of cases. We analyzed data from consecutive patients with empyema who underwent thoracotomy with open thoracic window drainage and using a negative pressure system in a third-level care hospital in the southeast of Mexico between October 2015 and June 2017. Results: we analyzed 6 cases. Median of age was 46 years (interquartile range 34-47), and 67% were male. The negative pressure system was placed during the postsurgical period, with a median of 6 days (interquartile range 5-7). The mean permanence time was 61 days (IQR 43-148). Finally, the length of hospital stay was 72 days (IQR 49-87). 67% of the cases had thoracic window closure and adequate lung expansion. Conclusions: in patients with chronic empyema, an integral therapy including thoracic window thoracotomy with a negative pressure system is an acceptable treatment strategy. More studies are required in order to ratify the results more objectively.