AI Article Synopsis
- Empyema is a common condition involving pus in the pleural space, but there is no clear consensus on the best initial treatment method, which could include chest tube insertion with fibrinolytics or surgical decortication.
- A randomized control trial will compare these two management strategies for adult patients with empyema to determine their effectiveness in preventing further interventions within 30 days.
- The study will assess various outcomes, including re-intervention rates, size of empyema, length of hospital stay, and overall patient quality of life.
Article Abstract
Background: Empyema is a common thoracic surgery presentation, defined as pus in the pleural space. Despite the commonality of empyema, consensus on initial management remains ambiguous. Two standard of care treatment options include inserting a chest tube (thoracostomy) and the administration of intrapleural fibrinolytics, or an initial surgical approach, surgical decortication. Due to the complexity of this pleural space infection, often repeat interventions are required after initial management in order to achieve source control and resolution of clinical symptoms. This study aims to identify the most effective initial management option for empyema.
Study Design: We present a study protocol for a randomized control trial (RCT) comparing adult individuals with empyema to one of two standard of care initial management options. Participants will be randomized into either interventional radiology guided chest tube insertion with intrapleural fibrinolytics (Dornase 5 mg and Alteplase 10 mg intrapleural twice daily for three days) or video-assisted thoracoscopic surgery (VATS) decortication.
Methods: All adults with empyema meeting inclusion criteria will be invited to participate. They will be randomized into one of two intervention groups; interventional radiology guided chest tube insertion with fibrinolytics or initial VATS decortication. Each intervention will take place within 48 hours of randomization. The primary outcome will be the rate of re-intervention within 30 days. Re-intervention is defined as repeat chest tube insertion, VATS decortication, or decortication via thoracotomy. Secondary outcomes include a change in the size of empyema, length of stay, morbidity, as well as 30-day and 90-day mortality, as well as quality of life measurements.
Anticipated Impact: This study is aimed at identifying the most effective initial management option for individuals with empyema.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105624 | PMC |
| http://dx.doi.org/10.1016/j.conctc.2021.100777 | DOI Listing |
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