Rigid thorascopic debridement and continuous pleural irrigation in the management of empyema

Study objective: To determine the role of rigid thoracoscopy and continuous pleural irrigation as an alternative to thoracotomy in critically ill patients. Design/setting/patients/interventions: Thirteen patients with empyema (one bilateral) underwent thorascopic decortication and continuous postoperative irrigation with normal saline solution. Seven patients required preoperative ventilator support. Measurements and results: Double-lumen intubation was utilized in only two cases. Empyemas were drained effectively in all patients, including nine patients in whom dense adhesions were encountered. Mean duration of irrigation was 3.5 +/- 0.5 days. There were no deaths. One patient developed a recurrent empyema 1 week after resolution of symptoms and underwent thoracotomy. Conclusions: Rigid thorascopic decortication is an effective method for treating empyemas and can be considered before thoracotomy. It can be performed in patients who might not be candidates for video-assisted thorascopic approaches owing to inability to tolerate one-lung anesthesia or who have dense adhesions preventing lung collapse.