Short-term and long-term outcomes of intrathoracic vacuum therapy of empyema in debilitated patients.

Zsolt Sziklavari,Hans-Stefan Hofmann,Florian Zeman,Rudolf Schemm,Reiner Neu,Michael Ried,Christian Grosser,Tamas Szöke

doi:10.1186/s13019-016-0543-7

Zsolt Sziklavari, Hans-Stefan Hofmann + Show 6 more

Open Access

https://doi.org/10.1186/s13019-016-0543-7

Copy DOI

Abstract

BackgroundThis retrospective study analyzed the effectiveness of intrathoracic negative pressure therapy for debilitated patients with empyema and compared the short-term and long-term outcomes of three different intrapleural vacuum-assisted closure (VAC) techniques.MethodsWe investigated 43 consecutive (pre)septic patients with poor general condition (Karnofsky index ≤ 50 %) and multimorbidity (≥ 3 organ diseases) or immunosuppression, who had been treated for primary, postoperative, or recurrent pleural empyema with VAC in combination with open window thoracostomy (OWT-VAC) with minimally invasive technique (Mini-VAC), and instillation (Mini-VAC-Instill).ResultsThe overall duration of intrathoracic vacuum therapy was 14 days (5–48 days). Vacuum duration in the Mini-VAC and Mini-VAC-Instill groups (12.4 ± 5.7 and 10.4 ± 5.4 days) was significantly shorter (p = 0.001) than in the group treated with open window thoracostomy (OWT)-VAC (20.3 ± 9.4 days). No major complication was related to intrathoracic VAC therapy. Chest wall closure rates were significantly higher in the Mini-VAC and Mini-VAC-Instill groups than in the OWT-VAC group (p = 0.034 and p = 0.026). Overall, the mean postoperative length of stay in hospital (LOS) was 21 days (median 18, 6–51 days). LOS was significantly shorter (p = 0.027) in the Mini-VAC-Instill group (15.1 ± 4.8) than in the other two groups (23.8 ± 12.3 and 22.7 ± 1.5). Overall, the 30-day and 60-day mortality rates were 4.7 % (2/43) and 9.3 % (4/43), and none of the deaths was related to infection.ConclusionsFor debilitated patients, immediate minimally invasive intrathoracic vacuum therapy is a safe and viable alternative to OWT. Mini-VAC-Instill may have the fastest clearance and healing rates of empyema.

Highlights

This retrospective study analyzed the effectiveness of intrathoracic negative pressure therapy for debilitated patients with empyema and compared the short-term and long-term outcomes of three different intrapleural vacuum-assisted closure (VAC) techniques
Previous studies [3] have shown that accelerated open window thoracostomy (OWT) empyema drainage and resolution may be achieved with intrathoracic vacuum-assisted closure (OWT-VAC and NPWT: negative pressure wound therapy)
Our study showed that intrathoracic VAC technique offers a safe treatment option for pleural empyema with good short-term and long-term outcomes, in debilitated patients

Summary

Introduction

This retrospective study analyzed the effectiveness of intrathoracic negative pressure therapy for debilitated patients with empyema and compared the short-term and long-term outcomes of three different intrapleural vacuum-assisted closure (VAC) techniques. In critically ill patients or in the case of recurrent empyema, surgical treatment still represents a big challenge. In such cases, open window thoracostomy (OWT) allows rapid evacuation of Sziklavari et al Journal of Cardiothoracic Surgery (2016) 11:148. Previous studies [3] have shown that accelerated OWT empyema drainage and resolution may be achieved with intrathoracic vacuum-assisted closure (OWT-VAC and NPWT: negative pressure wound therapy). Intrathoracic negative pressure therapy can be minimally invasive without altering the integrity of the chest wall (Mini-VAC) [4]. Recent studies have shown that Mini-VAC and Mini-VACInstill may produce equivalent resolution rates and better OWT closure rates than open approaches [6]

Methods

Results

Discussion

Conclusion