Abstract
Objective:To confirm that either Fibrinolytic therapy or open decortication which of the two is an effective First line treatment of pleural empyema.Methods:This prospective comparative study was conducted in the department of surgery Sheikh Zayed Medical College and Hospital, Rahim Yaar Khan. Seventy eight (78) patients were included in this study. There were two groups of patients; Group I (n=35) patients treated with fibrinolytic therapy, Group II (n=43) patients treated with open decortication. Data was entered and analyzed in SPSS v16. Student’s t-test was used for comparison of quantitative variables. Chi-square and Fisher’s Exact test were used for comparison of qualitative variables. P-value ≤ 0.05 was taken as significant difference.Results:There was no significant difference in base baseline characteristics of patients of Group I and II. Incidence of comorbidities was also same between the groups. Most of the patients in Group I and II were in empyema stage III. Fluid cultures was positive in 33 (94.3%) patients in group I and 39 (90.7%) patients in group II. 30 (85.7%) was successfully treated using fibrinolytic therapy but this therapy failed in five (14.3%) patients, two of these patients expired within the hospital. There was only one (2.3%) treatment failure in open decortication Group that patient expired within the hospital (p-value 0.04). Overall duration of hospitalization was significantly high in fibrinolytic group, this was 17.6± 1.95 days versus 12.09± 2.18 days in open decortication group (p-value<0.0001). There was no significant difference regarding operative mortality within the two groups.Conclusion:Open Drainage is associated with better outcomes as compared to fibrinolytic therapy when used as a First line treatment of empyema.
Highlights
The presence of purulent fluid within the pleural space is known as pleural empyema,[1] caused by invasions of pathogens into the pleural space
Multiple studies have shown that fibrinolytic therapy along with tube thoracostomy is an effective treatment for the management of fibrinopulurent and organizing empyema with a success rate ranging from 38-100%
There was no significant difference in the base baseline characteristics of patients of Group I and II
Summary
The presence of purulent fluid within the pleural space is known as pleural empyema,[1] caused by invasions of pathogens into the pleural space. There are three stages of empyema described by The American Thoracic Society; Stage I (exudative stage), Stage II (fibrinopurulent stage), Stage III (organizing stage).[3] Treatment of empyema ranges from simple antibiotic administration to insertion of pigtail catheters, tube thoracostomy or surgical intervention e.g. open drainage and Video-assisted thoracoscopic surgery.[4] Stage I can be treated using closed chest drainage and optimal antibiotic therapy with a success rate of about 80%.5. Multiple studies have shown that fibrinolytic therapy along with tube thoracostomy is an effective treatment for the management of fibrinopulurent and organizing empyema with a success rate ranging from 38-100%.6. Fibrinolytic therapy has shown to be superior to chest tube drainage only.[7,8] When these therapies fails the ultimate treatment is surgical intervention Multiple studies have shown that fibrinolytic therapy along with tube thoracostomy is an effective treatment for the management of fibrinopulurent and organizing empyema with a success rate ranging from 38-100%.6 Fibrinolytic therapy has shown to be superior to chest tube drainage only.[7,8] When these therapies fails the ultimate treatment is surgical intervention
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