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Meta-Analysis
. 2021 Apr 20;21(1):127.
doi: 10.1186/s12890-021-01492-9.

Medical thoracoscopy treatment for pleural infections: a systematic review and meta-analysis

Michele Mondoni  1 , Laura Saderi  2 , Federica Trogu  2 , Silvia Terraneo  3 , Paolo Carlucci  3 , Filippo Ghelma  4 , Stefano Centanni  3 , Giovanni Sotgiu  2
Affiliations
Meta-Analysis

Medical thoracoscopy treatment for pleural infections: a systematic review and meta-analysis

Michele Mondoni et al. BMC Pulm Med. .

Abstract

Background: Complicated parapneumonic effusions and empyema represent advanced stages of pleural infections and are characterized by a high mortality. Medical thoracoscopy is a safe and minimally invasive endoscopic technique prescribed to treat severe pleural infections. However, only a few studies evaluated its success rate. A systematic review of observational studies was performed to assess the efficacy of medical thoracoscopy in patients with complicated parapneumonic effusions and empyema, as well as its predictive factors.

Methods: A search of the scientific evidence was carried out using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. Articles describing observational studies on medical thoracoscopy in patients with parapneumonic effusions and empyema were selected.

Results: Eight studies met the inclusion criteria. The pooled treatment success rate of thoracoscopy was 85% (95% CI 80.0-90.0%; I2: 61.8%) when used as first-line intervention or after failure of chest tube. The pooled complication rate was 9.0% (95% CI 6.0-14.0%; I2: 58.8%). A pooled difference of treatment success of 9.0% (95% CI 1.0-18.0%) was found when post-thoracoscopy intra-pleural fibrinolysis was prescribed. Pooled success rate was higher in cases with pleural fluid culture negativity (pooled difference: 14.0%; 95% CI 4.0-24.0%).

Conclusions: Medical thoracoscopy is effective and safe when prescribed for complicated parapneumonic effusions and empyema. Bacteriological negativity of pleural effusion specimens and administration of adjuvant intra-pleural fibrinolysis after the procedure are associated with a higher success rate.

Keywords: Empyema; Intra-pleural fibrinolysis; Medical thoracoscopy; Parapneumonic effusion; Pleural infections; Pleuroscopy.

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Conflict of interest statement

Dr. Michele Mondoni and Prof. Giovanni Sotgiu are senior editorial board members of BMC Pulmonary Medicine.

Figures

Fig. 1
Fig. 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 flow diagram
Fig. 2
Fig. 2
Treatment success rate of medical thoracoscopy in complicated parapneumonic effusion and empyema
Fig. 3
Fig. 3
Success rate differences according to the administration of post-thoracoscopy intra-pleural fibrinolysis
Fig. 4
Fig. 4
Success rate differences according to detection of bacteriological infection
See this image and copyright information in PMC

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