Comparison of closed-chest drainage with rib resection closed drainage for treatment of chronic tuberculous empyema

Successful Treatment of Critically Severe Empyema With Bronchopleural Fistula via ECMO: A Case Report

Empyema is one of the most dangerous complications in thoracic surgery. It can easily progress to severe empyema with life-threatening conditions that are extremely challenging to treat. We successfully treated a patient with critically severe empyema via extracorporeal membrane oxygenation (ECMO), and the patient eventually recovered and was discharged. A 64-year-old male developed empyema 5 years ago. The thoracic infection led to a breakdown of the left chest wall. During hospitalisation, the patient's condition gradually deteriorated. We promptly initiated ECMO support and performed multiple debridement surgeries, fistula closure, targeted anti-infection treatment, and nutritional support. Ultimately, the patient's condition improved, as he eventually recovered and was discharged.

Risk factors for tuberculous empyema in pleural tuberculosis patients

Tuberculous empyema (TE) is associated with high mortality and morbidity. In the retrospective cohort study, we aimed to find risk factors for TE among pleural tuberculosis (TB) patients. Between July 2011 and September 2015, all culture-confirmed pleural TB patients (474 cases) were enrolled in our study. Empyema was defined as grossly purulent pleural fluid. Demographic and epidemiological data were collected for further analysis. Multivariate logistic regression analysis was used to evaluate risk factors of TE in pleural TB, age–adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated to show the risk. The mean age was 35.7 ± 18.1 years old, males comprised 79.1% of the participants (375 cases). Forty-seven patients (9.9%) were multidrug-resistant TB (MDR-TB), 29 (6.1%) had retreatment TB, 26 (5.5%) had diabetes mellitus. The percentage of empyema patients was 8.9% (42 cases). Multivariate analysis revealed that male (adjusted OR = 4.431, 95% CI: 1.411, 13.919), pleural adenosine deaminase (ADA, >88 U/L) (adjusted OR = 3.367, 95% CI: 1.533, 7.395) and white blood cell (WBC, >9.52 10⁹/L) (adjusted OR = 5.763, 95% CI: 2.473, 13.431) were significant risk factors for empyema in pleural TB, while pulmonary TB (adjusted OR = 0.155, 95% CI: 0.072, 0.336) was the protective factor for the patients. TE remains a serious threat to public health in China. Male sex is a significant risk factor for TE while the presence of pulmonary TB is protective, and high levels of pleural ADA and WBC count could aid in early diagnosis of TE. This finding would help towards reducing the mortality and morbidity associated with TE.