Open Window Thoracostomy for Pleural Empyema Complicating Partial Lung Resection

Summary A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed: Is open window thoracostomy (OWT) the only method to control infection in patients with an empyema following pulmonary resection for primary lung cancer? Altogether 442 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Empyema following anatomical lung resection (excluding pneumonectomy) is an uncommon complication but one that remains a challenge to treat effectively. Chest tube thoracostomy and intravenous antibiotics remain the initial steps to management, but evidence is lacking with regard to the best ongoing strategy. Conservative options including chest cavity irrigation, postural drainage and vacuum-assisted closure have been attempted with some success, even in the presence of a broncho-pleural fistula. However, the very limited number of patients on which these various management strategies have been trialled on prevents recommendations and clear guidance being given.

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Mini-thoracostomy with vacuum-assisted closure: a minimally invasive alternative to open-window thoracostomy

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562017000000167 ◽

2018 ◽

Vol 44 (3) ◽

pp. 227-230

Author(s):

Alessandro Wasum Mariani ◽

João Bruno Ribeiro Machado Lisboa ◽

Guilherme de Abreu Rodrigues ◽

Ester Moraes Avila ◽

Ricardo Mingarini Terra ◽

...

Keyword(s):

Minimally Invasive ◽

Treatment Option ◽

Pleural Empyema ◽

Minimally Invasive Technique ◽

Stage Iii ◽

Invasive Technique ◽

Vacuum Assisted Closure ◽

Initial Sample ◽

Open Window ◽

Open Window Thoracostomy

ABSTRACT Thoracostomy is a common treatment option for patients with stage III pleural empyema who do not tolerate pulmonary decortication. However, thoracostomy is considered mutilating because it involves a thoracic stoma, the closure of which can take years or require further surgery. A new, minimally invasive technique that uses the vacuum-assisted closure has been proposed as an alternative to thoracostomy. This study aims to analyze the safety and effectiveness of mini-thoracostomy with vacuum-assisted closure in an initial sample of patients.

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Open-window thoracostomy in pleural empyema

European Journal of Cardio-Thoracic Surgery ◽

10.1016/1010-7940(92)90186-2 ◽

1992 ◽

Vol 6 (12) ◽

pp. 635-638 ◽

Cited By ~ 10

Author(s):

F SMOLLEJUTTNER ◽

W BEUSTER ◽

H PINTER ◽

G PIERER ◽

M PONGRATZ ◽

...

Keyword(s):

Pleural Empyema ◽

Open Window ◽

Open Window Thoracostomy

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Open window thoracostomy for a chronic calcified pleural empyema in the setting of a closed chest trauma

SAGE Open Medical Case Reports ◽

10.1177/2050313x211025437 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110254

Author(s):

H Harmouchi ◽

Y Hamraoui ◽

M Lakranbi ◽

L Belliraj ◽

FZ Lamouime ◽

...

Keyword(s):

Chest Trauma ◽

Bronchopleural Fistula ◽

Pleural Empyema ◽

Chest Ct ◽

Fluid Level ◽

Closed Chest ◽

Open Window ◽

Open Window Thoracostomy ◽

Chest Ct Scan ◽

Closed Chest Trauma

This case report is a chronic calcified pleural empyema in a patient who suffered a closed chest trauma 30 years ago. The first goal is to demonstrate how the closed chest trauma caused a bronchopleural fistula of the calcified pleural empyema, since the patient began to report continued purulent sputum after his trauma with weight loss and the appearance of an air-fluid level in the chest CT scan (no pleurocutaneous fistula in the clinical examination). The second goal is to reveal the rule and the interest of an open window thoracostomy in the management of chronic calcified pleural empyema, since a decortication remains difficult to perform in cases like this one.

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