Abstract
BackgroundComplicated parapneumonic effusions and empyema represent advanced stages of pleural infections and are characterized by a high mortality. Medical thoracoscopy is a safe and minimally invasive endoscopic technique prescribed to treat severe pleural infections. However, only a few studies evaluated its success rate. A systematic review of observational studies was performed to assess the efficacy of medical thoracoscopy in patients with complicated parapneumonic effusions and empyema, as well as its predictive factors.MethodsA search of the scientific evidence was carried out using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. Articles describing observational studies on medical thoracoscopy in patients with parapneumonic effusions and empyema were selected.ResultsEight studies met the inclusion criteria. The pooled treatment success rate of thoracoscopy was 85% (95% CI 80.0–90.0%; I2: 61.8%) when used as first-line intervention or after failure of chest tube. The pooled complication rate was 9.0% (95% CI 6.0–14.0%; I2: 58.8%). A pooled difference of treatment success of 9.0% (95% CI 1.0–18.0%) was found when post-thoracoscopy intra-pleural fibrinolysis was prescribed. Pooled success rate was higher in cases with pleural fluid culture negativity (pooled difference: 14.0%; 95% CI 4.0–24.0%).ConclusionsMedical thoracoscopy is effective and safe when prescribed for complicated parapneumonic effusions and empyema. Bacteriological negativity of pleural effusion specimens and administration of adjuvant intra-pleural fibrinolysis after the procedure are associated with a higher success rate.
Highlights
Complicated parapneumonic effusions and empyema represent advanced stages of pleural infections and are characterized by a high mortality
A total of eight studies were selected for the qualitative and quantitative analysis; 200 studies were excluded for the following reasons: other topics (n = 74), only abstract available (n = 71), reviews (n = 17), case-reports (n = 8), case-series with less than ten patients (n = 7), Video Assisted Thoracoscopic Surgery (VATS) (n = 8), letters (n = 5), editorials (n = 3), articles written in languages than English (n = 3), randomized controlled trials (n = 1), studies without any results (n = 2), and full-text not available (n = 1)
In conclusion, this systematic review and meta-analysis shows that medical thoracoscopy is an effective and safe minimally invasive technique for the treatment of complicated parapneumonic effusion and empyema
Summary
Complicated parapneumonic effusions and empyema represent advanced stages of pleural infections and are characterized by a high mortality. Medical thoracoscopy (i.e., thoracoscopy performed with local anaesthesia under conscious sedation) is a safe and minimally invasive endoscopic technique, which is prescribed for several pleural diseases (e.g. diagnosis of pleural effusions of unknown aetiology or suspected for malignancy, talc poudrage pleurodesis in pleural neoplasms and pneumothorax) [7,8,9]. It shows several advantages if compared with conventional medical therapy, in cases of multi-loculated pleural effusion [7,8,9]. Current guidelines do not recommend its use for the above-mentioned indications, following the absence of any evidence from randomized controlled trials on the efficacy in the management of pleural infections [4, 7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
