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. 2016 May-Jun;33(3):267-71.
doi: 10.4103/0970-2113.180802.

Management of chronic empyema with unexpandable lung in poor surgical risk patients using an empyema tube

Abhishek Biswas  1 , Michael A Jantz  1 , Andrea M Penley  1 , Hiren J Mehta  1
Affiliations

Management of chronic empyema with unexpandable lung in poor surgical risk patients using an empyema tube

Abhishek Biswas et al. Lung India. 2016 May-Jun.

Abstract

Objectives: High preoperative risk precludes decortication and other surgical interventions in some patients with chronic empyema. We manage such patients by converting the chest tube into an "empyema tube," cutting the tube near the skin and securing the end with a sterile clip to allow for open pleural drainage. The patient is followed serially, and the tube gradually withdrawn based on radiological resolution and amount of drainage.

Methods: Between 2010 and 2014, patients with chronic empyema and unexpandable lung, deemed high-risk surgical candidates, had staged chest tube removal, and were included for the study. The volume of fluid drained, culture results, duration of drainage, functional status, and comorbidities were recorded.

Measurements and results: Eight patients qualified. All had resolution of infection. The tube was removed after an average of 73.6 ± 49.73 (95% confidence interval [CI]) days. The mean duration of antibiotic treatment was 5.37 ± 1.04 (95% CI) weeks. None required surgery or experienced complications from an empyema tube.

Conclusion: A strategy of empyema tube drainage with staged removal is an option in appropriately selected patients with chronic empyema, unexpandable lung, and poor surgical candidacy.

Keywords: Chronic empyema; empyema tube; unexpandable lung.

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Figures

Figure 1
Figure 1
Empyema tube in position. Approximately 4 cm of the empyema-tube extends out of the chest wall with the rest still inside the pleural space. The metal clip prevents the tube from being dislodged into the pleural space. The tube is covered with a sterile gauze or with a colostomy bag based on the amount of drainage
Figure 2
Figure 2
Sequential radiographs demonstrating gradual resolution of empyema. A pigtail is visible in the right empyema cavity (a). The pigtail has been replaced by a surgical chest tube in anticipation of discharge with an empyema tube (b). The chest tube has been converted into an empyema tube (c) and a clip has been placed over the chest tube to prevent the accidental retraction of the tube into the pleural space. The empyema cavity has resolved and the empyema tube has been removed (d). A small pleural scar has replaced the empyema cavity
Figure 3
Figure 3
A pigtail has been placed to drain the right-sided empyema (a). The pigtail has been replaced with a surgical chest tube; the pus has been mostly drained and a hydropneumothorax remains (b). The chest tube is cut close to the skin surface and a clip applied to it to prevent accidental retraction of the tube into the pleural space (c). The empyema tube has been removed (d). A linear vertical pleural scar remains as a result of the empyema, but the infection has been controlled along with expansion of the ipsilateral lung
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