Electrolyzed Saline Irrigation for Elimination of Bacterial Colonization in the Empyema Space

Abstract

Background: The empyema space is refractory to elimination of bacterial colonization. Electrolyzed saline (ES) was used as intra-pleural irrigation for rapid disinfection of the empyema space.Patients and Methods: Twenty consecutive patients with para-pneumonic empyema were reviewed in this study from 2007 to 2015. The empyema space was irrigated by miniaturized thoracoscopic surgery (mini VATS), and the efficacy and safety of the use of ES were evaluated.Results: Sixteen patients were male and four were female, with a mean age of 66.5 ± 9.5 y (27–90 y). Bacterial cultures of the purulent effusions from all 20 patients had positive results. Seventeen patients subsequently underwent continuous catheter irrigation and drainage. No patient had chest pain during ES irrigation. Fever duration after mini VATS was 2.8 ± 1.8 d (0–5 d). Catheter indwelling time was 10.3 ± 7.2 d (3–33 d). Inflammatory markers significantly improved (p < 0.05) within a week after mini VATS. Eighteen patients achieved pleural disinfection, and two patients had residual pathogens, one of whom later died of lung abscess. Space closure was successful in 14 patients. No patient underwent subsequent open drainage. Nineteen (95%) patients were discharged from the hospital. This treatment was successful in 18 (90%) patients, and one (5.6%) patient experienced recurrence.Conclusions: The ES irrigation facilitates the rapid disinfection and closure of the empyema space.

The effect of a novel slow-flow irrigation drainage tube on anastomotic leakage and empyema after the resection of esophageal or gastroesophageal junction cancer

“…Meanwhile, the location of empyema cavity might be so elusive that traditional drainage tube fails to approach, even if the tube placement is guided with CT, ultrasound, or endoscopy. Inspired by the idea that irrigation facilitates the rapid disinfection and closure of the empyema space by Nakamoto et al (12), we attempted to ameliorate this system in the treatment of anastomotic leakage with peri-anastomotic empyema cavity.…”

Should Empyema Space Be Surgically Closed?: A Case Report of Pleural Irrigation with Electrolyzed Saline for Postoperative Empyema

“…We have demonstrated that intrapleural irrigation with ES solution was an effective and less invasive strategy for parapneumonic empyema without bronchofistula [3]. ES solution has broad spectrum bactericidal activity, including for viruses and fungi, is superior to povidone iodine, and has no adverse effects on biological tissues because of immediate conversion to water after contact with organisms [3,5]. Prompt ES irrigation reduced the use of parenteral antibiotics [4].…”

“…Principal treatment for empyema is cleansing and closure of the infected pleural dead space [1]. ES irrigation promptly eliminated bacterial colonies in the empyema space and facilitated epithelization of the pleura under closed space drainage [3]. Organic or protein substances deactivated the bactericidal activities of ES solution, continuous irrigation was frequently required for the maintenance of the activity level [2] and the disruption of the microbe biofilms [5].…”

“…The medical cost for long term usage of custom made ES solution is inexpensive [3]. ES production is simple with an electrolysis generator without sterilization [3], and ES solution was listed in the 2008 CDC guidelines [3] as a novel disinfectant. ES solution has resolved postoperative empyema, a major complication of esophagectomy.…”

“…Postoperative empyema is a major complication of esophageal resection, requiring emergency surgery in high risk cardiopulmonary states [1,2]. Custom made electrolyzed saline (ES) with an electrolysis generator (Oxilyzer Medical C-L, Koken Ltd., Tokyo) using a 0.1% salt and tap water mixture is a current ultimate disinfectant for biological tissues [3], and its use for less invasive irrigation promptly cured empyema [4]. We performed ES irrigation for postoperative empyema from esophagectomy, and herein report the treatment strategies used in this case.…”