Behind The Knife: The Surgery Podcast Clinical Challenges in Thoracic Surgery: Complex Pleural Effusions & Empyema - Part 1 of 2
Aug 14, 2023
Dr. Jed Gorden, an interventional pulmonologist known for his research on pleural infections, joins the surgical team to delve into managing complex pleural effusions and empyema. They explore the debate between intrapleural fibrinolytic therapy versus surgical options. Gorden discusses various drainage techniques, comparing small- and large-bore chest tubes. Evidence is reviewed, suggesting surgery might lead to better outcomes. The team emphasizes the importance of shared decision-making with patients, balancing clinical options and personal preferences.
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Prioritize Antibiotics And Diagnostic Drainage
- Broadly cover antibiotics and ensure anaerobic coverage when pleural infection progresses despite therapy.
- Place a chest tube and send pleural fluid studies (cell count, LDH, pH, protein, glucose) for diagnosis and source control.
Use Ultrasound And Consider 14F Pigtail
- Use ultrasound to identify loculations and target the best site for catheter placement.
- Favor a 14-French pigtail for combined sampling and continuous drainage when complex effusion is likely.
Trade-Offs Between Small And Large Tubes
- Small-bore catheters offer comfort and mobility but risk clogging and require careful management.
- Larger tubes may drain better but increase discomfort and impede mobilization.