| Thoracic empyema: current opinions in medical and surgical management. | |
| | |
MedLine Citation:
|
PMID: 20224409 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
PURPOSE OF REVIEW: Empyema is defined as pus in the thoracic cavity due to pleural space infection and has a multifactorial underlying cause, although a majority of them are post-bacterial pneumonia caused by tuberculosis or by infection following penetrating chest injuries or surgical procedures. It is still associated with significant morbidity and mortality in adults and children despite optimal management according to current guidelines. Historically, empyema management has been empirical, but more recent data are leading to more focused management guidelines. RECENT FINDINGS: The number of therapeutic agents licensed for intrapleural use or undergoing clinical trials in the management of empyema continues to expand, although their use is currently controversial and probably best limited to trials and specialist centers. Although their use is limited by availability, ultrasound and guided aspiration is the investigation of choice in suspected empyema. It is safer, more sensitive, provides more information, and, in the case of guided-drainage, is more likely to be effective. Finally, there is a growing body of literature that supports very early involvement of thoracic surgeons in empyema management. An emerging question for the future is whether some or indeed all patients with empyema should now bypass medical thoracostomy and proceed directly to video-assisted thoracoscopic surgery for both acute and chronic empyemas. SUMMARY: A summary of the most recent opinions and results in thoracic empyema management is outlined. Treatment of empyema can be summarized as appropriate antibiotic therapy combined with medical or surgical pleural space drainage, management of any underlying factors, with further surgery indicated for chronic disease. |
| | |
Authors:
|
Simon F Lee; David Lawrence; Helen Booth; Stephen Morris-Jones; Bruce Macrae; Alimuddin Zumla |
Related Documents
:
|
8740389 - Correction of genital prolapse. 11460299 - Restoration of lower eyelid support in facial paralysis. 15058449 - Blood conservation in total joint arthroplasty: blood as a drug. 14560909 - Stage iv posterior tibial tendon insufficiency: the tilted ankle. 925249 - The management of pressure sores. 8009289 - Unusual rectal perforation--an individualised approach to management. 11823769 - How relevant are the systematic reviews in the cochrane library to emergency medical pr... 15798069 - Informatics in radiology (inforad): survey of personal digital assistant use in radiology. 21049219 - Difficult-to-control asthma management through the use of a specific protocol. |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
|
Title: Current opinion in pulmonary medicine Volume: 16 ISSN: 1531-6971 ISO Abbreviation: Curr Opin Pulm Med Publication Date: 2010 May |
Date Detail:
|
Created Date: 2010-04-08 Completed Date: 2010-07-13 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 9503765 Medline TA: Curr Opin Pulm Med Country: United States |
Other Details:
|
Languages: eng Pagination: 194-200 Citation Subset: IM |
Affiliation:
|
Department of Medical Microbiology, University College London Hospital NHS Foundation Trust, London, UK. sflee@ibmc.up.pt |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Anti-Bacterial Agents / therapeutic use* Combined Modality Therapy Drainage / methods Empyema, Pleural / diagnosis, drug therapy*, surgery* Female Follow-Up Studies Humans Male Middle Aged Randomized Controlled Trials as Topic Risk Assessment Severity of Illness Index Thoracic Surgery, Video-Assisted / methods* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
|
0/Anti-Bacterial Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Pleural fluid tests to identify complicated parapneumonic effusions.
Next Document: New and improved tuberculosis diagnostics: evidence, policy, practice, and impact.