Chest
Laboratory and Animal InvestigationsThe Utility of Daily Therapeutic Thoracentesis for the Treatment of Early Empyema
Section snippets
Materials and Methods
This project was approved by the Animal Studies Committee at the Department of Veterans Affairs Medical Center, Long Beach, CA, prior to the start of the study. Forty-nine rabbits weighing from 2.0 to 3.0 kg were divided into three groups. The experimental group consisted of 16 rabbits that underwent daily therapeutic thoracentesis starting 24 h after empyema induction. A second group of 14 rabbits underwent chest tube placement at 24 h after empyema induction. A third group of 19 rabbits
Results
The initial diagnostic thoracentesis performed 24 h after bacterial injection revealed that the rabbits had pleural effusions with a mean pleural fluid pH < 7.10 and a mean pleural fluid glucose< 15 mg/dL (Table 1), consistent with empyema formation. There were no significant differences in the mean pleural fluid pH and glucose values among the three different groups (Table 1).
The mortality rate in the therapeutic thoracentesis group (0/16) did not differ significantly (p = 0.155) from that in
Discussion
The present study demonstrates that in our rabbit model of empyema, serial therapeutic thoracentesis is at least as effective as chest tube placement. Relative to the group of rabbits that were treated with chest tubes, the rabbits that received daily therapeutic thoracentesis had significantly lower gross empyema scores, and a trend toward a lower mortality rate. Pleural peel scores and the proportion of animals with pus at autopsy were comparable in the therapeutic thoracentesis group and the
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Cited by (27)
Pleural infection: Past, present, and future directions
2015, The Lancet Respiratory MedicineCitation Excerpt :In view of the therapeutic primacy of achieving successful drainage of infected material from the pleural space, most studies have focused on how this might be best achieved, for example, through chest tube drainage (with or without intrapleural fibrinolytics) or by surgical intervention. A subset of patients might exist, however, in whom outpatient management using therapeutic thoracentesis only whenever needed or for whom drainage is not even necessary, is an acceptable strategy.121 The development of a method for the identification of these patients using a combination of clinical, radiological, biochemical, and microbiological data might help reduce treatment costs through avoidance of hospital admission.
Parapneumonic pleural effusions: Epidemiology, diagnosis, classification and management
2015, Revue des Maladies RespiratoiresThe Approach to the Patient with a Parapneumonic Effusion
2006, Clinics in Chest MedicinePharmacokinetic study of pleural fluid penetration of carbapenem antibiotic agents in chemical pleurisy
2006, Respiratory MedicineCurrent issues in the diagnosis and management of pediatric empyema
2002, Seminars in Pediatric Infectious DiseasesCitation Excerpt :Another small study found that chest tube drainage and antibiotics alone were sufficient treatment for all 14 patients in the study; even those patients with pleural peel were clinically well after approximately 2 weeks of treatment.15 Sasse and colleagues46,47 argue that the early placement of chest tubes (within 48 hours of the onset of disease) or repeated daily thoracentesis results in lower rates of pleural peel formation and fewer treatment failures. Although the studies use a rabbit model, they do tend to confirm the utility of chest tube drainage.46,47
Presented in abstract form at the International Conference on Chest Medicine in San Francisco, CA, October, 1996.
Dr. Teixeira is supported in part by Fundacao De Amparo a Pesquisa Do Estado de Sao Paulo, Brazil, and in part by the Saint Thomas Foundation, Nashville, TN.