Hospital-acquired (healthcare-acquired) pleural infection — typically arising secondary to nosocomial pneumonia, trauma, or surgery — where initial drainage-based management has been attempted but has not achieved adequate resolution.
The prior intervention, intrapleural fibrinolytic therapy (IPFT), failed to produce improvement in radiographic clearance and effective drainage of the infected pleural space. This protocol addresses the next step when those goals remain unmet.
Surgical intervention is the recommended next step in this setting, with video-assisted thoracoscopic surgery (VATS) as the preferred approach. The full sequence of surgical options — including when and how each applies — is contained in the complete protocol.
Lung re-expansion and maintenance of a sterile pleural space.
DOI: 10.1183/20734735.0146-2023
In the hospital-acquired setting, pleural infection usually arises secondary to nosocomial pneumonia, trauma and surgery.
The principles of surgery in management of empyema focus on debridement and evacuation of the infected material from the pleural cavity.
Advances in surgery have led to an increase in the use of VATS as the preferred approach in managing pleural infection.
In advanced stages of pleural infection, the visceral pleura develops a thick rind; therefore, decortication is required to allow lung re-expansion and to maintain a sterile pleural space thereafter.
View source ↗