medigraphic.com
ISSN 1561-2945 (Print)

2016, Number 1

<< Back Next >>

Revista Cubana de Cirugía 2016; 55 (1)

Thoracic window and local anesthesia in pleural suppuration

Mederos CON, Olewasegun AA, Mederos TOL, Barrera OJC, Castellanos GJA

Language: Spanish
References: 40
Page: 30-39
PDF size: 105.10 Kb.


ABSTRACT

Introduction: pleural cavity purulent collection causes high mortality and complications in lung infections processes. It often comes to patients with deterioration of general condition, a situation muchworsened in patients of geriatric age.
Objective: to show the experience in using costal thoracostomy and local anesthesia in care for elderly patients with pleural empyema and poor physical condition.
Methods: study carried out in 24 patients with pleural empyema, advanced age and poor physical condition cared for from January 1998 to October 2015 at Comandante Manuel Fajardo University Hospital and who also underwent pleurocutaneous window with local anesthesia.
Results: average age was 72 years. The male/female ratio was 3 to 1. 75 % of the patients presented associated diseases. The most frequent cause was infested parapneumonic effusion. There was pleurostomy history in 100% of the cases, negative culture in 20.8 %, while the most common germs were streptococcus, staphylococcus and gram-negative bacteria. The resected ribs were the sixth and seventh previous costal arches. El average windows closing time was 8 months. There was no surgical mortality.
Conclusion: pleurocutaneous thoracic window is a surgical procedure with low mortality, ideal to settle a pleural cavity tabicada with great utility in patients at geriatric age and in precarious physical condition, from the feasibility of being performing under local anesthesia.


REFERENCES

  1. Bekele Jembere B, Mederos Curbelo ON, Valdés Jiménez J, Barreras Ortega JC, Romero Díaz CA, Cantero Ronquillo A. Manejo escalonado en la supuración pleural. Rev. Cubana Cir. 2002;41(3):141-6.

  2. Ahmed AE, Yacoub TE. Empyema thoracis. Clin Med Insights Circ Respir Pulm Med. 2010;4:1-8.

  3. Mederos Curbelo ON, Cantero Ronquillo A, Romero Díaz C, Moret González J. Del derrame pleural paraneumonico al empiema. Revista Española Cirugía, Casos Clínicos. 2006;1(2):2-5.

  4. Mederos Curbelo ON, Del Campo AR, Valdés Jiménez J, Barreras Ortega JC, Romero Díaz CA, Cantero Ronquillo A et al. Ventana torácica con anestesia local. Alternativa en el enfermo grave con empiema pleural. Arch Cir. Gen Dig. Mar 21, 2005. © Cirugest. [citado 15 de mayo de 2014]. Disponible en: http://www.cirugest.com/revista/2005/06/2005-03-21.htm

  5. Mederos Curbelo ON, Guerra Pereda E, Barreras Ortega JC, Romero Díaz CA, Cantero Ronquillo A. Empiema pleural, fístula bronco-pleuro-cutánea y ventana torácica. Arch Cir. Gen Dig. 2005-Mar-28 [citado 15 de mayo de 2014]. Disponible en: http://www.cirugest.com/revista/2005/07/2005-03-28.htm

  6. Meyer CN, Rosenlund S, Nielsen J, Friis-Moller A. Bacteriological a etiology and antimicrobial treatment of pleural empyema. Scand J Infect Dis. 2011;43:165-9.

  7. Kundu S, Mitra S, Mukherjee S, Das S. Adult thoracic empyema: A comparative analysis of tuberculous and non tuberculous etiology in 75 patients. Lung India. 2010;27:196-201.

  8. Elloesser L. An operation for tuberculous empyema. Surg Gynecol Obstet. 1935;60:1096-7.

  9. Clagget OT, Geraci JE. A procedure for the management of Post-Neumonectomy empyema. J Thorac Cardiovasc Surg. 1963;45:141-5.

  10. Vikkula L, Konstiainen S. Postneumonectomy empyema in pulmonary carcinoma patients. Scand J Thorac Cardiovasc Surg. 1970;4:267-77.

  11. Weissberg D. Empyema and bronchopleural fistula. Experience with Open Window Thoracostomy. Chest. 1982;4:47-50.

  12. Nakajima Y. Toracostomía en ventana abierta y la transposición de colgajo de músculo dorsal en empiema. 2010;63(8):684-91.

  13. Regnard JF, Alifano M, Puyo P, Fares E, Magdeleinat P, Levasseur P. Open window thoracostomy followed by intrathoracic flap transposition in the treatment of empyema complicating pulmonary resection. J Thorac Cardiovasc Surg. 2000;120:270-5.

  14. Zaheer S, Allen MS, Cassivi SD, Nichols FC, Johnson CH, Deschamps C. Postpneumonectomy empyema: results after the Clagett procedure. Ann Thorac Surg. 2006;82:279-86.

  15. Deslauriers J, Jacques LF, Gregoire J. Role of Eloesser flap and thoracoplasty in the third millennium. Chest Surg Clin North Am. 2002;12:605-23.

  16. Massera F, Robustellini M, Pona CD, Rossi G, Rizzi A, Rocco G. Predictors of successful closure of open window thoracostomy for postpneumonectomy empyema. Ann Thorac Surg. 2006;82:288-92.

  17. Maekawa Ykehara RL, Amez Olivera JM, Castañeda Saldaña E. Ventana torácica en el tratamiento del empiema pleural crónico en el Hospital Nacional Cayetano Heredia, 1990-1998. Rev Med Hered. 2002;13(3):32-45.

  18. Smolle Juttner F, Beuster W, Pinter H, Pierer G, Pongratz M, Friehs G. Open windows thoracostomy in pleural empyema. Eur Journal Cardiothorac. 1992;6(12):635-8.

  19. Leone RR, Torres AD, Salgado R. Ventana torácica en el tratamiento del empiema pleural crónico. Revista Argertina de Cirugia. 1988;55:132-4.

  20. Eerola S, Virkkula L, Varstela E. Treatment of postpneumonectomy empyema and associated bronchopleural fistula. Scand Journal Thorac Cardiovasc. 1988;22:235-8.

  21. Simmons EM, Sauer P, Elkadi A, Mackenzie JW, Almond CH. Review of Non - Tuberculous Empyema at the University of Missouri Medical Center from 1957 To 1971. Journal Thorac Cardiovasc Surg. 1972;64:578-85.

  22. Belmahi S, Ouezzani S, el Aziz. Muscular flaps and reconstructive surgery of empyema: about 12 cases. Ann Chir Plast Esthet. 2008;53:1-8.

  23. Krassas R, Grima P, Bagan A, Badia A, Arame F. Le Pimpec Barthes Current indications and results for thoracoplasty and intrathoracic muscle transposition. Eur J Cardiothorac Surg. 2010;37:1215-20.

  24. Fournier T, Krueger Y, Wang A, Meyer HB, Ris M, Gonzalez T. Thoracomyoplasty as a valid treatment option for chronic postlobectomy empiema. Ann Thorac Surg. 2012;94:387-93.

  25. Hen KC, Lin JW, Tseng YT, Kuo SW, Huang PM, Hsu HH. Thoracic empyema in patients with liver cirrhosis: clinical characteristics and outcome analysis of thoracoscopic management. J Thorac Cardiovasc Surg. 2012;143:1144-51.

  26. Zahid I, Nagendran M, Routledge T, Scarci M. Comparison of video-assisted thoracoscopic surgery and open surgery in the management of primary empyema. Curr Opin Pulm Med. 2011;17:255-9.

  27. Tong BC, Hanna J, Toloza EM, Onaitis MW, D'Amico TA, Harpole DH, et al. Outcomes of video-assisted thoracoscopic decortication. Ann Thorac Surg. 2010;89:220-5.

  28. Lee SF, Lawrence D, Booth H, Morris-Jones S, Macrae B, Zumla A. Thoracic empyema: current opinions in medical and surgical management. Curr Opin Pulm Med. 2010;16:194-200.

  29. Chambers A, Routledge T, Dunning J, Scarci M. Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema? Interact Cardiovasc Thorac Surg. 2010;11:171-7.

  30. Christie NA. Management of pleural space: effusions and empyema. Surg Clin North Am. 2010;90:919-34.

  31. Shiraishi Y. Surgical treatment of chronic empyema. Gen Thorac Cardiovasc Surg. 2010;58:311-6.

  32. Tacconi F, Pompeo E, Fabbi E, Mineo TC. Awake video-assisted pleural decortication for empyema thoracis. Eur J Cardiothorac Surg. 2010;37:594-601.

  33. Carr JA, Fales C, Shaikh IA, Foulds K. Computed tomographic modeling before and after treatment for posttraumatic empyema: early decortication is superior to catheter drainage. Ann Thorac Surg. 2011;91:1723-8.

  34. Manunga J, Olak J. Is thoracoscopic decortication sufficient for the treatment of empyema? Am Surg. 2010;76:1050-4.

  35. Jiang L, Jiang GN, He WX, Fan J, Zhou YM, Gao W, et al. Free rectus abdominis musculocutaneous flap for chronic postoperative empyema. Ann Thorac Surg. 2008;85:2147-9.

  36. Massera F, Robustellini M, Della Pona C, Rossi G, Rizzi A, Rocco G. Open window thoracostomy for pleural empyema complicating partial lung resection. Ann Thorac Surg. 2009;87:869-73.

  37. Bar I, Stav D, Fink G, Peer A, Lazarovitch T, Papiashvilli M. Thoracic empyema in high-risk patients: conservative management or surgery? Asian Cardiovasc Thorac Ann. 2010;18:337-43.

  38. Mederos Curbelo ON, Del Campos Abad R, Barrera Ortega JC, Romero Días C, Cantero Ronquillo A. El gran reto de la cirugía torácica no cardiaca en edades geriátricas. Arch Cir Gen Dig. Cirugest [revista en la Internet]. 2006 [citado 2013 jul 18];may 29. Disponible en: http://www.cirugest.com/revista/2006/04/2006-05-29.htm

  39. Chen KC, Lin JW, Tseng YT, Kuo SW, Huang PM, Hsu HH. Thoracic empyema in patients with liver cirrhosis: clinical characteristics and outcome analysis of thoracoscopic management. J Thorac Cardiovasc Surg. 2012;143:1144-51.

  40. Sziklavari Z, Grosser C, Neu R, Schemm R, Kortner A, Szöke T. Complex pleural empyema can be safely treated with vacuum-assisted closure. J Cardiothorac Surg. 2011;6:130.




2020     |     www.medigraphic.com