Early medical thoracoscopy for pleural infection may shorten hospital stay

Early medical thoracoscopy for patients with multiloculated pleural infection and empyema was safe and shortened the length of hospital stay compared with intrapleural fibrinolytic therapy, according to new data.

“Medical thoracoscopy has the advantage of mechanically breaking loculations and septations in the pleural space, which will facilitate pleural fluid drainage, lavage and targeted placement of the chest tube,” Fayez Kheir, MD, pulmonologist, critical care specialist and internist in the division of pulmonary diseases, critical care and environmental medicine at Tulane University Health Sciences Center, and colleagues wrote in the Annals of the American Thoracic Society. “Furthermore, this minimally invasive procedure can be done under moderate sedation and local anesthesia without the need for single lung ventilation or general anesthesia.”

Researchers conducted a prospective, multicenter, randomized controlled clinical trial to compare the safety and efficacy of early medical thoracoscopy vs. intrapleural fibrinolytic therapy. Although both are acceptable treatments for complicated pleural infection, the researchers described “a lack of comparative data for these modes of management.”

The study included 32 patients who underwent medical thoracoscopy (n = 16; median age, 65 years; 87.5% men) or intrapleural fibrinolytic therapy (n = 16; median age, 58 years; 62.5% men) for multiloculated pleural infection and empyema. Primary outcome was length of hospital stay after each intervention. Secondary outcomes included total length of hospital stay, treatment failure, 30-day mortality and adverse events.

Median length of hospital stay after intervention was 2 days in the medical thoracoscopy group compared with 4 days in the intrapleural fibrinolytic therapy group (P = .026). Median total length of hospital stay was 3.5 days in the medical thoracoscopy group compared with 6 days in the intrapleural fibrinolytic therapy group (P = .12). Follow-up for all patients occurred 4 to 6 weeks after hospital discharge, and no patients were readmitted 30 days after either intervention.

Researchers observed no significant differences in treatment failure (medical thoracoscopy, four patients vs. intrapleural fibrinolytic therapy, three patients), mortality (one death vs. no deaths), adverse events (one in each group) or serious complications related to medical thoracoscopy and intrapleural fibrinolytic therapy.

“Medial thoracoscopy is a minimally invasive procedure that is safe and effective for the treatment of early pleural infection in a select population and might shorten hospital stays as compared with intrapleural fibrinolytic therapy when performed in high-volume pleural centers by experienced interventional pulmonologists,” the researchers wrote. “A multicenter trial with a larger sample size is needed to confirm our findings.”