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VATS Decortication Versus IR Guided Chest Tube Insertion With Fibrinolytics for the Management of Empyema

Empyema, Pleural

The American Association of Thoracic Surgery defines empyema as pus in the pleural space. It is a common thoracic surgery presentation with an estimated 65,000 cases occurring annually in the United States. Despite the high prevalence of empyemas, there has been no consensus as to its optimal first line management. Methods of acceptable treatment currently include chest tube insertion (thoracostomy), thoracostomy with fibrinolytics, decortication via a thoracotomy (removal of fibrous peel on the lung) and video-assisted thoracoscopic surgery (VATS) decortication. The investigators aim to determine the rate of re-intervention within thirty days for adults presenting with empyema in the fibrinopurulent phase by comparing the initial treatments of Interventional Radiology (IR) guided chest tube insertion with intrapleural fibrinolytics (as per Multi-Institutional Sepsis 2 Trial; MIST 2 Trial) versus VATS decortication. Currently, either of these treatments is considered first-line depending on the surgeon and institutional preference.

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Participation Requirements

  • Sex:

    ALL

  • Eligible Ages:

    18 and up

Participation Criteria

Inclusion Criteria:

* CT Chest confirming the presence of a parapneumonic effusion
* Diagnostic thoracentesis values: pH\<7.2, Glucose \<2.2mmol/L or LDH \>1000IU/L with the presence of pus
* Ability to undergo general anesthesia, no allergies to anesthetic agents or DNAse/streptokinase, no rapidly fatal underlying illness and the ability to tolerate single lung ventilation

Exclusion Criteria:

* Younger than age 18
* Pregnant
* Symptoms for six weeks or longer with a pleural peel on CT chest of ≥ 10mm thick as this would preclude patients to be better managed by thoracotomy rather than VATS
* Exhibiting signs of shock (hypotension, altered mental state etc)
* Participants cannot participate in any other clinical trials during the trial period

Study Location

Queen's University/Kingston Health Sciences Centre
Queen's University/Kingston Health Sciences Centre
Kingston, Ontario
Canada

Contact Study Team

Primary Contact

Leah Garrison

[email protected]
6135496666
Study Sponsored By
Queen's University
Participants Required
More Information
Study ID: NCT03584113