Other Treatment OptionsIn the prese

Other Treatment Options
In the presence of an advanced stage empyema with multiple loculations and/or thick pleural peel, surgical consultation for video-assisted thorascopic surgery (VATS), decortication, or open thoracotomy should be sought. The reported efficacy of VATS is variable, with small studies documenting failure rates (defined as conversion to open thoracotomy) between 29% and 44%7,8,9 However, decortication has been shown to have outcomes at least as good as open thoracotomy; one nonrandomized study of 420 patients showed decreased mortality in patients undergoing decortication as opposed to open thoracotomy (8% versus 16%, respectively).10
Additionally, surgical consultation should be considered in cases when tube thoracostomy with fibrinolytics fails. Early debridement or thoracotomy in good surgical candidates has been shown to reduce morbidity and mortality in the event of tube thoracostomy failure.2 Referral to VATS or thorascopic debridement should be performed as early as reasonably possible; negative predictive factors for conversion to open thoracotomy include >2 weeks delayed referral and infection with gram-negative organisms.7
Teaching Points/Pearls
1. An empyema is an infected exudative pleural effusion containing pus.
2.Although typically resulting from a parapneumonic effusion, empyema can occur secondary to trauma, surgery, esophageal perforation, or spread from adjacent abscess or osteomyelitis.
3.The split pleura sign is seen on CECT and is highly suggestive of empyema in the febrile patient.
4.Staphylococcus aureus is the most common organism.
5.Small-bore catheters can be used just as effectively as larger ones when drainage of an early stage empyema is performed.
6.When feasible, a lateral approach utilizing the Seldinger or trocar technique under ultrasound/fluoroscopic guidance is preferred.
7.Fibrinolytic agents such as 10 mg tPA can be instilled twice a day for a total of 3 days to break loculations and improve the effectiveness of catheter drainage.
8.Mucolytic agents like 5 mg DNase are combined with fibrinolytics to decrease the viscosity of the infected fluid.
9.Surgical consultation for thoracotomy or VATS should be sought in cases of more advanced stage empyema with multiple loculations and/or thick pleural peel.

結果 (中文) 1:

其他的治疗方法在与多个 loculations 和/或厚厚的胸腔果皮晚期脓胸，应该寻求外科会诊视频辅助胸腔镜手术 (VATS)、 脱皮，或开胸手术。电视胸腔镜手术的报道的效果是变量，记录失败率 (定义为中转开胸手术) 29%和 44%之间的小型研究 7,8,9 然而，脱皮已被证明有结果至少一样好开胸手术;一对 420 例患者的非随机研究表明降低脱皮而不是常规开胸手术患者的死亡率 (8%和 16%，分别).10此外，外科会诊应考虑在情况下，与 fibrinolytics 引流失败时。早期清创或开胸手术中适合外科手术已被证明减少发病率和死亡率在管胸腔置 failure.2 转诊到电视胸腔镜或胸腔镜清创应尽早合理;中转开胸手术的消极预测因素包括 > 2 周延误转诊和感染革兰阴性杆菌 organisms.7教学点/珍珠1.脓胸是含脓感染的渗出性胸腔积液。2.虽然通常因肺炎旁积液，脓胸可继发于创伤、 手术、 食管穿孔或传播从相邻脓肿或骨髓炎。3.分裂胸膜标志被认为是对 CECT 和高度提示发热患者脓胸。4.金黄色葡萄球菌是最常见的有机体。5.Small 孔导管可以用作只是作为较大的有效地执行性早期阶段脓胸时。6.在可行的情况下，采用 Seldinger 或套管针技术在超声透视监视下的外侧入路是首选。7.溶纤维蛋白制剂等 10 毫克 tPA 可以灌输一天两次，共 3 天，打破 loculations，提高置管引流的疗效。8.祛痰剂像 5 毫克头结合 fibrinolytics 来降低感染的流体的粘度。9.外科开胸手术或胸腔镜咨询应在与多个 loculations 和/或厚厚的胸腔果皮的更高级阶段脓胸的情况下寻求。

結果 (中文) 3:

其他的治疗方案
在与多个loculations和/或厚胸膜剥晚期脓胸的存在，电视胸腔镜手术（VATS）外科会诊，脱皮，或开胸手术应寻求。疗效VATS是可变的，有小的研究记录失败率（定义为中转开胸手术）29%和44%之间的数，9然而，剥除术已被证明有效果至少为开胸手术为好；一个非随机的420例患者的研究表明，在接受开胸手术患者术与死亡率降低（8%和16%，分别）。10
此外，外科会诊应考虑胸腔置管失败与纤维蛋白溶解。在良好的手术候选人早期清创手术已被证明可以减少胸腔置管失败的事件的发病率和死亡率。2推荐胸腔镜或胸腔镜清创应早期进行合理的可能；中转开胸的阴性预测因子包括> 2周革兰阴性菌感染7
延误转诊。教学点/珍珠1。脓胸是一种感染渗出性胸腔积液中含有脓液。
2.although典型肺炎旁胸腔积液积脓引起，可继发于外伤，手术，食管穿孔的发生或蔓延，从相邻的脓肿或骨髓炎。
3.胸膜分裂迹象是CECT高度提示脓胸发热的病人。
4。金黄色葡萄球菌是最常见的生物。
5.small-bore导管可以有效地为较大时进行早期脓胸引流。
6.when可行，外侧入路利用Seldinger导管或套管技术在超声/透视者优先。
7。纤溶制剂如10 毫克TPA可以灌输的一天两次共3天突破loculations提高导管引流的效果。
8.mucolytic剂如5 mg DNase结合纤维蛋白溶解减少感染的流体的粘度。
9。对于电视胸腔镜或外科会诊应寻求与多个loculations和/或厚胸膜剥下更高级的阶段
脓胸。