Abbreviations and Acronyms:
AATS (The American Association for Thoracic Surgery), BPF (bronchopleural fistula), CT (computed tomography), CXR (chest x-ray), IOM (Institute of Medicine), LOE (level of evidence), MRI (magnetic resonance imaging), US (ultrasound), VAC (vacuum-assisted closure), VATS (video-assisted thoracoscopic surgery)
Objective
Methods of Review
Institute of Medicine. Clinical practice guidelines we can trust. Available at: http://iom.nationalacademies.org/reports/2011/clinical-practice-guidelines-we-can-trust.aspx. 2011. Accessed December 6, 2015.

Introduction
Clinical Presentation
Recommendations
- 1.Class I: The presence of a pleural effusion should be investigated in all patients presenting with signs and symptoms of pneumonia or unexplained sepsis (LOE B).
- 2.Class I: Failure of a community- or healthcare-associated pneumonia to respond clinically to appropriate antibiotic therapy should prompt investigations to identify the presence of a pleural effusion (LOE B).
Reasoning
Imaging Studies
Recommendations
- 1.Class I: Pleural ultrasound (US) should be performed routinely in addition to conventional chest x-ray (CXR) in the evaluation of pleural space infection, both for diagnostic purposes and image-guidance for pleural interventions (LOE B).
- 2.Class IIa: Computed tomography (CT) of the chest should be obtained when pleural space infection is suspected (LOE B).
Reasoning
Chest x-ray
Pleural US
Computed tomography
Positron emission tomography and magnetic resonance imaging (MRI)
Laboratory and Pleural Fluid Analysis
Recommendations
- 1.Class I: The presence of pus, positive Gram's stain, or culture in the pleural fluid establishes the diagnosis of empyema, which should be treated with tube thoracostomy followed by surgical intervention when appropriate (LOE B).
- 2.Class I: A pleural pH <7.2 in a patient with suspected pleural space infection predicts a complicated clinical course, and tube thoracostomy should be performed followed by surgical intervention when appropriate (LOE B).
- 3.Class IIa: A pleural fluid LDH >1000 IU/L, glucose <40 mg/dL, or a loculated pleural effusion suggests that the pleural effusion is unlikely to resolve with antibiotics alone, and we recommend tube thoracostomy (LOE B).
- 4.Class I: Obtain pleural fluid culture specimens during aspiration or drainage procedures, not from previously inserted tubes or drains (LOE B). Inoculate freshly drained pleural fluid into aerobic and anaerobic blood culture vials in addition to sterile containers for gram stain and culture (LOE B).
General laboratory studies
Thoracentesis: Technique and sample processing
Pleural fluid analysis and biomarkers
Pleural fluid culture
Acute Pleural Empyema: Antibiotic Treatment
Recommendations
- 1.Appropriate empiric antibiotic therapy for acute pleural empyema incorporates an understanding of (1) the patient's clinical history, (2) local antimicrobial resistance patterns, (3) institutional antibiotic stewardship, and (4) pharmacologic characteristics of the antibiotics. Recommendations include:
- a.Class IIa: For community-acquired empyema: a parenteral second- or third-generation cephalosporin (eg, ceftriaxone) with metronidazole or parenteral aminopenicillin with β-lactamase inhibitor (eg, ampicillin/sulbactam) (LOE C).
- b.Class IIa: For hospital-acquired or postprocedural empyema: include antibiotics active against methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa (eg, vancomycin, cefepime, and metronidazole or vancomycin and piperacillin/tazobactam [dosed for activity against P aeruginosa]) (LOE C).
- c.Class I: Avoid aminoglycosides in the management of empyema (LOE B).
- d.Class IIa: There is no role for intrapleural administration of antibiotics (LOE C).
- a.
- 2.Class I: If possible, choose antibiotic therapy based on culture results (LOE C).
- a.Class IIa: Consider continuing anaerobic coverage empirically when the anaerobic cultures are negative (LOE C).
- a.
- 3.Class IIb: The duration of antibiotic therapy for acute bacterial empyema is influenced by the organism, adequacy of source control, and clinical response (LOE C).
Reasoning
Acute Pleural Empyema: Pleural Drainage
Thoracentesis
Recommendation
Image-Guided Drain Placement
Recommendations
- 1.Class I: Image-guided pleural drain placement is useful in the treatment of early-stage, minimally septated empyema (LOE B).
- 2.Class IIa: In septated effusions, placement of small bore catheters are recommended in patients that are not surgical candidates (LOE C).
- 3.Class I: Routine drain flushing is recommended to prevent occlusion (LOE B).
- 4.Class I: Tube thoracostomy should be combined with close CT follow-up to confirm adequacy of drainage. Persistence of any undrained fluid should prompt additional drains or more aggressive management (LOE C).
Reasoning
Acute Pleural Empyema: Intrapleural Fibrinolytic Therapy
Recommendation
Reasoning
- Thommi G.
- Shehan J.C.
- Robison K.L.
- Christensen M.
- Backemeyer L.A.
- McLeay M.T.
Study | Year | Sample size | Chest tube size, F | Intervention | Outcomes |
---|---|---|---|---|---|
Tuncozgur et al 81 | 2001 | 49 | 24-36 | Urokinase, 100,000 IU OD × 3 d | Pleural fluid drainage Length of stay Rate of surgical intervention |
Diacon et al 82 | 2004 | 53 | 24-28 | Streptokinase, 250,000 IU OD × 7 d | Rate of surgical intervention |
Misthos et al 83 | 2005 | 127 | 28-32 | Streptokinase, 250,000 IU OD × 3 d | Length of stay Rate of surgical intervention |
MIST1 | 2005 | 454 | 12 (12-20) | Streptokinase, 250,000 IU OD × 3 d | Mortality Rate of surgical intervention |
MIST2 | 2011 | 210 | <15 | Alteplase 10 mg bid × 3 d and DNase 5 mg bid × 3 d | % of hemothorax occupied by effusion Rate of surgical intervention Length of stay |
Thommi et al 84
A double blind randomized cross over trial comparing rate of decortication and efficacy of intrapleural instillation of alteplase vs placebo in patients with empyemas and complicated parapneumonic effusions. Respir Med. 2012; 106: 716-723 | 2012 | 68 | 14-28 | Alteplase 25 mg OD × 3d | Rate of surgical intervention |
Acute Pleural Empyema: Surgical Management
Recommendation
Reasoning
Potential Benefits of VATS Over Open Thoracotomy
Potential Harm of VATS Over Open Thoracotomy
- Howington J.A.
- Gunnarsson C.L.
- Maddaus M.A.
- McKenna R.J.
- Meyers B.F.
- Miller D.
- et al.
Summary of Relevant Available Evidence
Quality: Retrospective, Cohort (LOE B)/Quantity: 10+ Studies/Consistency: Satisfactory
Expert Clinical Opinion

Chronic Empyema
Overview

Chronic Empyema: Decortication
Recommendations
- 1.Class IIa: Decortication is reasonable in patients with chronic empyemas who are medically operable to tolerate major thoracic surgery (LOE B).
- 2.Class IIb: There is no compelling evidence that epidural catheters cannot be used safely in patients with chronic empyema if they are otherwise low risk for epidural abscess (LOE C).
Reasoning
Potential Benefits of Epidural Anesthesia for Postoperative Pain Control
Potential Harm of Epidural Anesthesia for Postoperative Pain Control
Chronic Empyema: Space Filling of Chronic Empyema Cavities
Recommendations
Tissue flaps
Thoracoplasty
Reasoning
Chronic Empyema: Prolonged Treatment Measures
Open Thoracic Window
Recommendation
Wound Vacuum-Assisted Closure (VAC) Device
Recommendation
Empyema Tube
Recommendation
Reasoning
Postresectional Empyema
Postpneumonectomy Empyema
Recommendations
Reasoning
Empyema Associated with BPF
Recommendations
- 1.Class IIa: Closure of BPFs should be attempted with a combination of primary closure and buttressing with a well-vascularized transposed soft-tissue pedicle (LOE C).
- 2.Class IIb: Transposition of the omentum is preferred over skeletal muscle flaps or mediastinal soft tissue, and this should be attempted after the purulent fluid has been drained completely and the pleural cavity has a surface of granulation tissue (LOE C).
Closure devices
Fistula associated with necrotizing pneumonia
Management of the residual thoracic space
- 1.Class IIb: Primary chest closure should be attempted with the chest cavity filled with antibiotic solution after granulation tissue has formed in the chest cavity and if the patient is medically fit to undergo another operation (LOE B).
- 2.Class IIa: The creation of a permanent open thoracostomy window is an acceptable treatment strategy for patients treated for an empyema with a recurrent or persistent BPF who are medically unfit for another operation or for those with recurrent cancer (LOE C).
Pediatrics
Recommendations
- 1.Class I: Tube thoracostomy with or without the subsequent instillation of fibrinolytic agents should be attempted as the initial treatment for pediatric patients with an empyema (LOE A).
- 2.Class IIa: Thoracoscopic debridement and drainage is recommended in pediatric patients not responding adequately to tube thoracostomy and fibrinolytic instillation (LOE B).
- 3.Class IIa: VATS debridement is preferred rather than open thoracotomy for the surgical management of empyema in the pediatric population (LOE C).
Conflict of Interest Statement
References
Institute of Medicine. Clinical practice guidelines we can trust. Available at: http://iom.nationalacademies.org/reports/2011/clinical-practice-guidelines-we-can-trust.aspx. 2011. Accessed December 6, 2015.
- Parapneumonic effusions and empyema.Proc Am Thorac Soc. 2006; 3: 75-80
- The bacteriology of pleural infection by genetic and standard methods and its mortality significance.Am J Respir Crit Care Med. 2006; 174: 817-823
- Thoracic empyema in patients with community-acquired pneumonia.Am J Med. 2006; 119: 877-883
- Duration of hospitalization for bacteremic infections at Boston City Hospital during 12 selected years between 1935 and 1972.J Infect Dis. 1978; 138: 837-848
- Empyema of the thorax then and now. A study of 122 cases over four decades.Arch Intern Med. 1973; 131: 516-520
- U.K. Controlled trial of intrapleural streptokinase for pleural infection.N Engl J Med. 2005; 352: 865-874
- Anaerobic infections of the lung and pleural space.Am Rev Respir Dis. 1974; 110: 56-77
- Anaerobic bacterial infections of the lung and pleural space.Clin Infect Dis. 1993; 16: S248-S255
- Bacteriology of empyema.Lancet. 1974; 1: 338-340
- Bacteriological aetiology and antimicrobial treatment of pleural empyema.Scand J Infect Dis. 2011; 43: 165-169
- Risk factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia.Thorax. 2009; 64: 592-597
- Minimal detectable pleural effusions. A roentgen pathology model.Radiology. 1972; 105: 51-53
- The efficacy of chest radiographs in detecting parapneumonic effusions.Respirology. 2011; 16: 1000-1004
- Chest sonography versus lateral decubitus radiography in the diagnosis of small pleural effusions.J Clin Ultrasound. 2003; 31: 69-74
- Accuracy of pleural puncture sites: a prospective comparison of clinical examination with ultrasound.Chest. 2003; 123: 436-441
- Reducing iatrogenic risk in thoracentesis: establishing best practice via experiential training in a zero-risk environment.Chest. 2009; 135: 1315-1320
- Ultrasound-guided thoracentesis: is it a safer method?.Chest. 2003; 123: 418-423
- Emergency ultrasound evaluation of symptomatic nontraumatic pleural effusions.Am J Emerg Med. 2006; 24: 782-786
- Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography.Crit Care Med. 2005; 33: 1757-1763
- Value of sonography in determining the nature of pleural effusion: analysis of 320 cases.AJR Am J Roentgenol. 1992; 159: 29-33
- Transthoracic ultrasonography in predicting the outcome of small-bore catheter drainage in empyemas or complicated parapneumonic effusions.Ultrasound Med Biol. 2009; 35: 1468-1474
- Sonographic septation: a useful prognostic indicator of acute thoracic empyema.J Ultrasound Med. 2000; 19: 837-843
- Differentiating empyemas and peripheral pulmonary abscesses: the value of computed tomography.Radiology. 1980; 135: 755-758
- Differentiating lung abscess and empyema: radiography and computed tomography.AJR Am J Roentgenol. 1983; 141: 163-167
- Parietal pleural changes in empyema: appearances at CT.Radiology. 1990; 175: 145-150
- Pleural exudates and transudates: diagnosis with contrast-enhanced CT.Radiology. 1994; 192: 803-808
- The extrapleural fat in empyema: CT appearance.Br J Radiol. 1991; 64: 580-583
- Increasing incidence of empyema complicating childhood community-acquired pneumonia in the United States.Clin Infect Dis. 2010; 50: 805-813
- Prevalence and clinical significance of pleural microbubbles in computed tomography of thoracic empyema.Clin Radiol. 2006; 61: 513-519
- Computed tomography measurements of parapneumonic effusion indicative of thoracentesis.Eur Respir J. 2011; 38: 1406-1411
- What size parapneumonic effusions should be sampled?.Thorax. 2010; 65: 91
- Accuracy of FDG-PET for differentiating benign from malignant pleural effusions: a meta-analysis.Chest. 2015; 147: 502-512
- Differentiation between malignant and benign pleural effusion in patients with extra-pleural primary malignancies: assessment with positron emission tomography-computed tomography.Invest Radiol. 2005; 40: 204-209
- 18F-FDG PET imaging in assessing exudative pleural effusions.Nucl Med Commun. 2006; 27: 971-976
- MR imaging of pleural effusions.J Comput Assist Tomogr. 1990; 14: 192-198
- A prediction rule to identify allocation of inpatient care in community-acquired pneumonia.Eur Respir J. 2003; 21: 695-701
- Parapneumonic effusions.Am J Med. 1980; 69: 507-512
- The prognostic value of loculations in parapneumonic pleural effusions.Chest. 1986; 90: 852-856
- Predicting factors for outcome of tube thoracostomy in complicated parapneumonic effusion for empyema.Chest. 1999; 115: 751-756
- Letter: Low pleural fluid pH in parapneumonic effusion.Chest. 1975; 68: 273-274
- Diagnostically significant variations in pleural fluid pH in loculated parapneumonic effusions.Chest. 2004; 126: 2022-2024
- Comparison of pleural fluid pH values obtained using blood gas machine, pH meter, and pH indicator strip.Chest. 1998; 114: 1368-1372
- Clinically important factors influencing the diagnostic measurement of pleural fluid pH and glucose.Am J Respir Crit Care Med. 2008; 178: 483-490
- Does pleural fluid pH change significantly at room temperature during the first hour following thoracentesis?.Chest. 2000; 117: 1043-1048
- Pleural fluid pH in parapneumonic effusions.Chest. 1976; 70: 328-331
- Predictors of outcome and long-term survival in patients with pleural infection.Am J Respir Crit Care Med. 1999; 160: 1682-1687
- Immediate drainage is not required for all patients with complicated parapneumonic effusions.Chest. 1990; 97: 731-735
- Pleural fluid chemical analysis in parapneumonic effusions. A meta-analysis.Am J Respir Crit Care Med. 1995; 151: 1700-1708
- Elevated pleural fluid pH in Proteus mirabilis empyema.Chest. 1983; 84: 109-111
- Validity of cultures of fluid collected through drainage catheters versus those obtained by direct aspiration.J Clin Microbiol. 2001; 39: 66-68
- Blood culture bottle culture of pleural fluid in pleural infection.Thorax. 2011; 66: 658-662
- Prospective clinical and microbiological study of pleural effusions.Eur J Clin Microbiol Infect Dis. 1999; 18: 237-241
- Management of infections due to antibiotic-resistant Streptococcus pneumoniae.Clin Microbiol Rev. 1998; 11: 628-644
- Streptococcus milleri pulmonary disease: a review and clinical description of 25 patients.Thorax. 1995; 50: 1093-1096
- The etiology and antimicrobial susceptibility patterns of microorganisms in acute community-acquired lung abscess.Chest. 1995; 108: 937-941
- A comparative analysis of pharmacokinetics of ceftriaxone in serum and pleural fluid in humans: a study of once daily administration by intramuscular and intravenous routes.J Antimicrob Chemother. 1996; 8: 969-976
- Concentrations of ampicillin and sulbactam in serum and in various compartments of the respiratory tract of patients.Infection. 1994; 22: 149-151
- Antianaerobic antimicrobials: spectrum and susceptibility testing.Clin Microbiol Rev. 2013; 26: 526-546
- Clinicoradiographic correlation with the extent of Legionnaire disease.AJR Am J Roentgenol. 1983; 141: 263-268
- The radiologic manifestations of Legionnaire's disease. The Ohio Community-Based Pneumonia Incidence Study Group.Chest. 2000; 117: 398-403
- Radiographically guided percutaneous catheter drainage of pleural fluid collections.AJR Am J Roentgenol. 1988; 151: 1113-1116
- Thoracic empyema: management with image-guided catheter drainage.Radiology. 1988; 169: 5-9
- Image-guided catheter drainage of the infected pleural space.J Thorac Imaging. 1991; 6: 65-73
- CT- and ultrasound-guided catheter drainage of empyemas after chest-tube failure.Radiology. 1984; 151: 349-353
- Percutaneous catheter drainage of pleural effusion and empyema.AJR Am J Roentgenol. 1985; 144: 1189-1193
- The relationship between chest tube size and clinical outcome in pleural infection.Chest. 2010; 137: 536-543
- Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010.Thorax. 2010; 65: ii41-i53
- Image-guided percutaneous drainage of thoracic empyema: can sonography predict the outcome?.Eur Radiol. 2000; 10: 495-499
- Computed tomography and ultrasound in parapneumonic effusions and empyema.Clin Radiol. 2000; 55: 542-547
- Use of indwelling pleural catheters for chronic pleural infection.Chest. 2008; 133: 546-549
- Interventional radiology of pleural diseases.Respirology. 2011; 16: 419-429
- Small-bore wire-guided chest drains: safety, tolerability, and effectiveness in pneumothorax, malignant effusions, and pleural empyema.J Thorac Cardiovasc Surg. 2011; 141: 683-687
- Management of pleural effusion, empyema, and lung abscess.Semin Intervent Radiol. 2011; 28: 75-86
- A study of the complications of small bore ‘Seldinger’ intercostal chest drains.Respirology. 2008; 13: 603-607
- Efficacy and complications of small-bore, wire-guided chest drains.Chest. 2006; 130: 1857-1863
- Diagnosis of malpositioned chest tubes after emergency tube thoracostomy: is computed tomography more accurate than chest radiograph?.Clin Imaging. 2005; 29: 401-405
- The use of streptokinase-streptodornase in the treatment of chronic empyema; with an interpretive discussion of enzymatic actions in the field of intrathoracic diseases.J Thorac Surg. 1951; 21: 325-341
- Management of pleural space infections: a population-based analysis.J Thorac Cardiovasc Surg. 2007; 133: 346-351
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.J Clin Epidemiol. 2009; 62: 1006-1012
- Intrapleural urokinase in the management of parapneumonic empyema: a randomised controlled trial.Int J Clin Pract. 2001; 55: 658-660
- Intrapleural streptokinase for empyema and complicated parapneumonic effusions.Am J Respir Crit Care Med. 2004; 170: 49-53
- Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study.Eur J Cardio-Thorac Surg. 2005; 28: 599-603
- A double blind randomized cross over trial comparing rate of decortication and efficacy of intrapleural instillation of alteplase vs placebo in patients with empyemas and complicated parapneumonic effusions.Respir Med. 2012; 106: 716-723
- Intrapleural use of tissue plasminogen activator and DNase in pleural infection.N Engl J Med. 2011; 365: 518-526
- Intrapleural fibrinolytic therapy for treatment of adult parapneumonic effusions and empyemas: a systematic review and meta-analysis.Chest. 2012; 142: 401-411
- Video-assisted thoracoscopic lobectomy is less costly and morbid than open lobectomy: a retrospective multiinstitutional database analysis.Ann Thorac Surg. 2012; 93: 1027-1032
- Ninety-day costs of video-assisted thoracic surgery versus open lobectomy for lung cancer.Ann Thorac Surg. 2014; 98: 191-196
- Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema?.Interact Cardiovasc Thorac Surg. 2010; 11: 171-177
- Surgical management of primary empyema of the pleural cavity: outcome of 81 patients.Interact Cardiovasc Thorac Surg. 2010; 10: 565-567
- Surgical treatment of chronic empyema.Gen Thorac Cardiovasc Surg. 2010; 58: 311-316
- In-hospital clinical and economic consequences of pulmonary wedge resections for cancer using video-assisted thoracoscopic techniques vs traditional open resections: a retrospective database analysis.Chest. 2012; 141: 429-435
- Outcomes of video-assisted thoracoscopic decortication.Ann Thorac Surg. 2010; 89: 220-225
- Pleurectomy decortication in the treatment of the “trapped lung” in benign and malignant pleural effusions.Thorac Surg Clin. 2013; 23 (vi): 51-61
- Spinal epidural abscess: a meta-analysis of 915 patients.Neurosurg Rev. 2000; 23 (discussion 205): 175-204
- Epidural abscesses.Br J Anaesth. 2006; 96: 292-302
- The history of surgery of empyema, thoracoplasty, Eloesser flap, and muscle flap transposition.Chest Surg Clin N Am. 2000; 10 (viii): 45-53
- Approach to empyema necessitatis.World J Surg. 2011; 35: 981-984
- Omentoplasty for postpneumonectomy bronchopleural fistulas.Eur J Cardiothorac Surg. 1994; 8: 122-124
- Use of pedicled omental flap in treatment of empyema.Ann Thorac Surg. 1990; 50: 420-424
- Closure of bronchopleural fistulas by an omental pedicle flap.Am J Surg. 1986; 152: 40-42
- Thoracomyoplasty in the treatment of empyema: current indications, basic principles, and results.Pulm Med. 2012; 2012: 418514
- The Schede and modern thoracoplasty.Op Tech Thorac Cardiovasc Surg. 2000; 5: 128-134
- Surgery for parapneumonic pleural empyema—What influence does the rising prevalence of multimorbidity and advanced age has on the current outcome?.Surgeon. 2016; 14: 69-75
- Intrathoracic muscular transposition in chronic tuberculous empyema.Thorac Cardiovasc Surg. 2013; 61: 167-171
- Management of empyema cavity with the vacuum-assisted closure device.Ann Thorac Surg. 2006; 81: 723-725
- Vacuum-assisted closure device: a useful tool in the management of severe intrathoracic infections.Ann Thorac Surg. 2011; 91: 1582-1589
- Open drainage of massive tuberculous empyema with progressive reexpansion of the lung: an old concept revisited.Ann Thorac Surg. 1996; 62 (discussion 23-4): 218-223
- Bronchogenic carcinoma. Factors in survival.Arch Surg. 1967; 94: 539-549
- Elective pneumonectomy: factors associated with morbidity and operative mortality.Ann Thorac Surg. 1992; 54: 84-88
- Treatment of postpneumonectomy empyema and associated bronchopleural fistula. Experience of 100 consecutive postpneumonectomy patients.Scand J Thorac Cardiovasc Surg. 1988; 22: 235-239
- Indications, risks, and results of completion pneumonectomy.J Thorac Cardiovasc Surg. 1993; 105: 918-924
- Early and long-term results after completion pneumonectomy.Ann Thorac Surg. 1995; 59: 196-200
- Management of persistent bronchopleural fistulas.J Thorac Cardiovasc Surg. 1971; 62: 393-401
- Management of postpneumonectomy empyema and bronchopleural fistula.Chest Surg Clin N Am. 1996; 6: 519-527
- Management of late postpneumonectomy empyema and bronchopleural fistula.Chest Surg Clin N Am. 1996; 6: 529-541
- A procedure for the management of postpneumonectomy empyema.J Thorac Cardiovasc Surg. 1963; 45: 141-145
- Postpneumonectomy empyema. The role of intrathoracic muscle transposition.J Thorac Cardiovasc Surg. 1990; 99 (discussion 966-8): 958-966
- Postpneumonectomy empyema: results after the Clagett procedure.Ann Thorac Surg. 2006; 82: 279-286
- Accelerated treatment of postpneumonectomy empyema: a binational long-term study.Thorac Cardiovasc Surg. 2008; 136: 179-185
- Treatment strategies for bronchopleural fistula.J Thorac Cardiovasc Surg. 1995; 109: 989-995
- Open window thoracostomy followed by intrathoracic flap transposition in the treatment of empyema complicating pulmonary resection.J Thorac Cardiovasc Surg. 2000; 120: 270-275
- Predictors of successful closure of open window thoracostomy for postpneumonectomy empyema.Ann Thorac Surg. 2006; 82: 288-292
- Empyema and bronchopleural fistula after pneumonectomy: factors affecting incidence.Ann Thorac Surg. 2001; 72: 243-248
- Surgical treatment for bronchopleural fistula with omentum covering after pulmonary resection for non-small cell lung cancer.Thoracic Cancer. 2013; 4: 249-253
- Vascular occlusion device closure of bronchial stump fistulae: a straightforward approach to manage bronchial stump breakdown.Gen Thorac Cardiovasc Surg. 2012; 60: 847-850
- Use of Amplatzer device for endobronchial closure of bronchopleural fistulas.Interact J Cardiovasc Surg. 2009; 9: 901-902
- Use of Amplatzer device for endobronchial closure of bronchopleural fistulas.Chest. 2008; 133: 1481-1484
- Primary operative versus nonoperative therapy for pediatric empyema: a meta-analysis.Pediatrics. 2005; 115: 1652-1659
- Surgical management of bronchopleural fistula in pediatric empyema and necrotizing pneumonia: efficacy of the serratus anterior muscle digitation flap.J Pediatr Surg. 2012; 47: 1358-1362
- Of an operation for tuberculous empyema.Surg Gynecol Obstet. 1969; 60: 1096-1097
- Urokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial.Pediatrics. 2014; 134: 1301-1307
- Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial.J Pediatr Surg. 2009; 44: 106-111
- Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema.Am J Respir Crit Car Med. 2006; 174: 221-227
- Therapy of parapneumonic effusions in children: video-assisted thoracoscopic surgery vs. conventional thoracostomy drainage.Pediatrics. 2006; 118: 547-553
- Does VATS provide optimal treatment of empyema in children? A systematic review.J Pediatr Surg. 2004; 39: 381-386
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- Debunking dogma: The arduous task of writing AATS consensus guidelinesThe Journal of Thoracic and Cardiovascular SurgeryVol. 153Issue 6
- PreviewThe authors have provided consensus guidelines for the management of empyema.1 First, we need to express our appreciation to all of those who have sacrificed their time and energy to write guidelines and consensus statements over the years. It is an exceedingly arduous task, especially The American Association of Thoracic Surgery (AATS) guidelines consensus statements. As described in the methods section, the process should not be taken lightly. The entire world's literature is reviewed, the level of evidence is graded, and when data are not sufficient, expert consensus, often a complicated and contentious process, is reached; and this is not even the most impressive part of this article.
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