Toracocentese esvaziadora com irrigação e uso de antimicrobiano intrapleural no tratamento do empiema

Abstract

Background: Empyema is a serious disease classically characterized by purulence within the pleural cavity. Early diagnosis demands immediate treatment, although there is still great controversy surrounding the question of what is the best therapy.Objective: To analyze the method of using thoracentesis and pleural irrigation, combined with the intrapleural application of an antimicrobial agent, to treat empyema -and to compare this method with others described in the literature. Method:Between January 1999 and May 2000, 17 patients diagnosed with loculated or diffuse pleural empyema were submitted to thoracentesis, followed by thorough washing of the pleural cavity with isotonic solution and intrapleural administration of a non-irritating antimicrobial agent to the pleura. Results:The group of patients studied consisted of 15 men and 2 women, and the average age was 44. The most common clinical symptoms were fever, productive cough, chest pain and dyspnea, and the most common cause was pneumonia. Macroscopically, 12 patients presented obviously purulent pleural fluid. In 4 (26.67%) of the patients, the etiological agent was identified, the most frequent being Staphylococcus sp. Pulmonary decortication was indicated in 2 cases, and those 2 patients were therefore excluded. The average length of hospitalization was 17.1 days, although 3 patients received the treatment as outpatients. No recurrence or mortality was observed with the use of this methodology. Conclusion:This approach reduced the need for invasive procedures, proving to be safe and efficient, with lower rates of morbidity and mortality than other modalities of treatment.

Trachea and lung anatomy applied to clinical and surgical procedures in Sapajus libidinosus (Spix, 1823)

“…In the S libidinosus, thoracocentesis should be carried out similar to that suggested for dogs and cats, between the 7th, 6th, and 8th intercostal space, above the median line of the thorax . In humans, thoracocentesis can be made in the region of the 6th intercostal space, at the height of the posterior axillary line without damaging the lung parenchyma …”

“…13,33 In humans, thoracocentesis can be made in the region of the 6th intercostal space, at the height of the posterior axillary line without damaging the lung parenchyma. 34 Based on the results obtained on the trachea and lung anatomy applied to clinical and surgical emergency procedures for the species, the S libidinosus is similar to both wild and domestic animals but is different from humans.…”

Procedimentos minimamente invasivos: complicações também minimizadas ou subestimadas?

“…No primeiro deles, Dualibe et al (1) relatam sua experiência com o tratamento do empiema pleural através de toracocentese, irrigação do espaço pleural e uso de antimicrobiano intrapleural. Em 10 dos 15 casos tratados havia septações pleurais.…”