Empyema

If an empyema does not rupture, death will occur - Hippocrates

Empyema
Empyema

image by: Drriad

HWN Suggests

Jury is out, it's still reasonable to use a small bore chest tube to drain empyema

The incidence of empyema as a complication of pneumonia has been increasing since the 1990's and source control requires removing the pus from the chest as soon as possible, but how large should the drain be? The American Association for Thoracic Surgery (AATS) released the most recent guidelines for identifying and managing empyema in June 2017 and at the time had no certain evidence to guide the choice of large-bore vs small-bore catheters. Most studies to guide us are flawed (not randomized), but no recently published randomized studies exist to provide a definitive answer.

Bottom line: a small-bore pigtail catheter is a reasonable choice to drain empyema and flushing it every…

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Resources

 ED evaluation and management of pleural effusions: One size doesn’t fit all

If you suspect a parapneumonic effusion (whether it is uncomplicated, complicated, or an empyema), initiate the appropriate antibiotics (including anaerobic coverage).

 Jury is out, it's still reasonable to use a small bore chest tube to drain empyema

Bottom line: a small-bore pigtail catheter is a reasonable choice to drain empyema and flushing it every 6 hours has been shown to prevent clogging.

JETem

Empyema is defined as a pleural effusion which is grossly purulent or contains bacteria visualized on gram stain. Empyemas are most commonly associated with concurrent pneumonia or invasive procedures such as thoracotomy.

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