Video-Assisted Thoracoscopic Surgery in the Treatment of Complicated Parapneumonic Effusions or Empyemas

Luh, Shi‐Ping; Chou, Ming-Chih; Wang, Liang-Shun; Chen, Jia-Yuh; Tsai, Tsong-Po

doi:10.1016/s0012-3692(15)34497-4

Cited by 67 publications

(76 citation statements)

References 23 publications

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“…The mean length of stay was postoperative 12.8 days and overall 18.7 days. These data are comparable with the current literature (2,3,5,14). Complications occurred in 21%, mortality was 5.25%, whereas the first is also well comparable with the values in literature, the second one is slightly lower.…”

Section: Discussionsupporting

confidence: 91%

“…Current literature quotes a mean postoperative length of stay between 8 and 20 days in cases of thoracotomy due to empyema. Postoperative morbidity ranges from 11% to 42% (2)(3)(4)(5)15). Therefore, parapneumonic empyema is a disease with a high burden for the patient and the most appropriate therapy has to be selected as early as possible to decrease delay between diagnosis and surgery.…”

Section: Discussionmentioning

confidence: 99%

“…This interpretation focuses on advanced parapneumonic empyema where open decortication is foreseen. Early stages still profit from thoracoscopic drainage as early as possible (1)(2)(3)19).…”

Section: Discussionmentioning

confidence: 99%

“…Hence, the optimal moment is missed for a minimal invasive procedure providing a relevant input of infection control (2,3). Length of antibiotic treatment or bacterial spectrum is often unknown.…”

Section: Introductionmentioning

confidence: 99%

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Procalcitonin as preoperative marker for surgery in advanced parapneumonic empyema

et al. 2017

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Background: The optimal time point for surgical management of advanced parapneumonic empyema in need of open pleurectomy and decortication remains unclear. We hypothesized that surgical outcomes will be better when procalcitonin (PCT) levels have dropped to normal ranges as evidence for resolution of the underlying pneumonia. Results for postoperative length of stay were similar. Eight patients in the pPCT ≥0.25 μg/L group had postoperative complications with two deaths while no complications occurred in the PCT <0.25 μg/L group (38% vs. 0%, P=0.004).Conclusions: These data suggest better surgical outcomes in advanced parapneumonic empyema when pneumonia has resolved with a pPCT drop of <0.25 μg/L. A larger, prospective study is needed to confirm these results.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Procalcitonin as preoperative marker for surgery in advanced parapneumonic empyema

et al. 2017

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“…(28)(29) Estudos indicam que a videotoracoscopia higiênica no empiema foi mais eficaz, com hospitalização mais curta e menor custo, quando comparada à drenagem com uso de fibrinolíti-co.…”

Section: Pleuroscopiaunclassified

Derrame pleural parapneumônico e empiema

2006

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O derrame pleural parapneumônico (DPP) ocorre durante o curso clínico de uma pneumonia ou abscesso pulmonar. Sua incidência é freqüentemente subestimada, podendo aparecer em cerca de 25% a 44% dos casos de pneumonias adquiridas na comunidade (PAC).(1-3) Na maioria das vezes o quadro clínico do DPP se sobrepõe ao da PAC, sendo ele descoberto devido à realização da radiografia de tórax para o diagnóstico inicial ou avaliação da falta de resposta ao tratamento para a PAC.A maioria desses derrames é resolvida com o mesmo tratamento antibiótico da PAC, e sua presença pode passar despercebida. ABSTRACTThe infectious effusion, one of the most frequent causes of pleural effusions in the clinical practice, is a sign of complication of the pneumonic disease. The early recognition of the parapneumonic effusion is crucial to determine the best treatment form and reduce the risk of morbidity and mortality. The evolution in the diagnostic methods and the contribution of several studies published in the literature allowed to establish evidence-based guidelines that are used to guide the treatment of the parapneumonic pleural effusion and empyema.Keywords: Pneumonia/complications; Pleural effusion/etiology; Drainage; Empyema, pleural; Radiography, thoracic RESUMOO derrame infeccioso, uma das causas mais freqüentes de derrame pleural obervados na pratica clinica, é um sinal de complicação do quadro pneumônico. O reconhecimento precoce do derrame parapneumônico é fundamental para determinar a melhor forma de tratamento, reduzindo o risco de morbidade e mortalidade. A evolução dos métodos diagnósticos e a experiência dos diversos estudos publicados na literatura permitiram estabelecer diretrizes baseadas em evidencias que orientam a conduta de abordagem terapêutica do derrame parapneumônico e empiema.Descritores: Pneumonia/complicações; Derrame pleural/etiologia; Drenagem; Empiema pleural; Radiografia torácica tações (denominados de DPP complicados) ou para empiema pleural. (4)(5)(6) EPIDEMIOLOGIANo Brasil, existem estudos localizados em que a incidência de DPP se encontra entre 20% e 30% dos casos de PAC internados.(3-7) Em 2005, calculase que o número de pacientes com PAC internados foi de aproximadamente 730.000, (8) o que permite estimar entre 140.000 e 210.000 casos de DPP.Na literatura mundial, estima-se que 10% dos DPP podem evoluir para DPP complicado ou empiema pleural, (2) com a mortalidade situando-se entre 6% e 10% dos casos. (4,6) No Brasil, não dis- Capítulo 5Capítulo 5

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