Intrathoracic negative pressure therapy and/or endobronchial valve for pleural empyema minimal invasive management: case series of thirteen patients and review of the literature.

Abstract

Introduction: Intrathoracic negative pressure therapy is an adjunct to standard methods of complex empyema management in debilitated patients. Nevertheless, the use of endoscopic one-way endobronchial valves to successfully close large bronchopleural fistulas in patients with advanced pleural empyema has been described in only a few case reports. Aim: To present our experience in managing complex pleural empyema using thoracostomy with intrathoracic negative pressure therapy and/or endobronchial valve implantation. Material and methods: We retrospectively analyzed data from 13 consecutive patients (11 men, mean age: 56 years, range: 38-80 years) who were treated for pleural empyema using thoracostomy with intrathoracic negative pressure therapy and/or endobronchial valve implantation between October 2015 and November 2017. Results: The control of empyema was satisfactory in 12 patients; however, one patient died from sepsis-related multiorgan failure despite complete cessation of air leak on day 9 after endobronchial valve implantation. The overall success rate for the final closure of the chest wall was 9/12 patients (75%): in 5 patients, the wall closed spontaneously, and in 4, the wall was closed using thoracomyoplasty. Conclusions: Thoracostomy with intrathoracic negative pressure therapy, endobronchial valve implantation with tube drainage, and a combination of the two could adequately manage patients with pleural empyema with or without a persistent air leakage fistula.

Pleural empyema in children - benefits of primary thoracoscopic treatment.

“…A few case reports showed that thoracostomy with intrathoracic negative pressure therapy combined with endobronchial valve implantation could manage pleural empyema with broncho-pleural fistula [ 27 ], but in children this kind of treatment is technically complicated due to anatomical conditions (such as a narrow bronchial lumen).…”

Can intrapleural alteplase treatment be an alternative to videothoracoscopic deloculation and decortication in pleural empyema?

“…Empyema is of great importance to clinicians due to morbidity, mortality and hospital costs. Treatment options range from antibiotic therapy, thoracentesis, chest tube insertion, fibrinolytic therapy, intrathoracic negative pressure therapy and/or endobronchial valve implantation, to decortication with video-assisted thoracoscopic surgery (VATS) or thoracotomy [ 5 – 7 ]. The main goal in treatment is to increase lung expansion.…”

“…The main goal in treatment is to increase lung expansion. For this, it is aimed to drain the fibrin deposits by reducing the viscosity of the fluid in the thoracic cavity [ 7 , 8 ].…”