Management of thoracic empyema with broncho-pulmonary fistula in combination with negative-pressure wound therapy.

Abstract

Intrathoracic negative-pressure wound therapy (NPWT) has been introduced as a novel therapeutic device for the management of empyema. NPWT is expected to reduce the empyema cavity more rapidly than standard treatments; however, no objective analysis of the function of NPWT has yet been conducted. The study objective was to evaluate the efficacy of NPWT in the management of thoracic empyema. Ten patients with stage II or III thoracic empyema treated with NPWT were retrospectively analyzed. The volume of the empyema cavity was measured, and the volume change after the administration of NPWT was calculated. A comparison with the institutional historical controls was also performed. The patients had initially undergone fenestration of the chest wall for empyema, and eight had bronchopleural fistula and required procedures to close the fistula. The mean duration of NPWT was 71.1days (4-190days). The mean volume of the empyema cavity decreased from 230.2ml (42.8-788.4ml) to 78.5ml (5.2-185.3ml) by applying NPWT (P = 0.02), and the mean % decrease was 58.7% (0-87.9%). Ultimately, the empyema cavity was able to be cleaned in nine, including seven who were cured by subsequent thoracoplasty and two who were cured without thoracoplasty. The current study group had a tendency toward an early cure with less chest wall destruction, a less hospital stay after open window thoracotomy compared to historical control. NPWT enables the effective volume reduction and cleaning of the empyema cavity and achieves an early cure and reduced destruction of the chest wall.