Empyema
If an empyema does not rupture, death will occur - Hippocrates
image by: Drriad
HWN Recommends
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…
Resources
Empyema: ED Presentation, Evaluation, and Management
Maintain a low threshold for ordering CT Chest with IV contrast, as this is the most sensitive imaging modality for diagnosing and characterizing empyemas
Emergent Management of Empyema
Staphylococcus aureus is the most common organism. Small-bore catheters can be used just as effectively as larger ones when drainage of an early stage empyema is performed.
Empyema thoracis: new insights into an old disease
Pleural infection is one of the oldest and severest diseases. Drainage of the pleural cavity was attempted by Hippocrates over 2,000 years ago to treat empyema. During the influenza pandemic of 1917–1919, closed pleural drainage became widely practiced to treat post-pneumonic empyema.
Lung ultrasound: Empyema
Empyema is characterised typically by an inflammatory exudate, and on ultrasound this appears as echogenic, swirling fluid within a pleural effusion.
Massive Empyema
It is recommended that no more than 1500 mL of fluid be drained at one time or that the drainage be limited to no more than 500 mL/hour.
Pearl of the Day: Empyema
definitive treatment: drainage + antibiotics - respiratory or cardiac distress -> thoracentesis - recommended antibiotics: piperacillin/tazobactam 3.375 - 4.5 g IV q6h or imipenem 0.5 - 1 g IV q6h - may add vancomycin for increased risk of MRSA.
Pleural Effusion and Empyema
Despite advances in antimicrobial therapy and improved imaging, empyemas remain an important cause of morbidity and mortality. Delays in diagnosis, failure to start appropriate antimicrobial therapy, and inadequate drainage contribute to increased morbidity, mortality, and costs.
Pleural Effusions - Empyema
Today we discussed the case of an older man with alcohol use disorder with subacute-chronic cough, with recent 10-day course of amoxicillin for treatment of community acquired pneumonia, who was found to have unilateral pleural effusion found to be an empyema.
Pleural Space Infections/Empyema
Tuberculosis is a common cause of pleural effusion worldwide, but it is usually associated with a low mycobacterial load in the pleural cavity, and it normally develops as a type IV hypersensitivity reaction. Unlike standard bacterial pleural infection, acute presentation with TB pleuritis is uncommon, and dyspnea and constitutional symptoms develop insidiously.
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.
Introducing Stitches!
Your Path to Meaningful Connections in the World of Health and Medicine
Connect, Collaborate, and Engage!
Coming Soon - Stitches, the innovative chat app from the creators of HWN. Join meaningful conversations on health and medical topics. Share text, images, and videos seamlessly. Connect directly within HWN's topic pages and articles.
