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In considering pulmonary resection, a study of the literature and an observation of patients make it evident that the extent of lung tissue removed will influence the mortality rate, the incidence of morbidity, and the type of complications. Therefore, a survey of pulmonary resections should be divided into three classifications: pneumonectomy, lobectomy, and segmental and/or wedge resections. In the discussion of postoperative empyema, pulmonary resections should be divided into two major groups, (a) pneumonectomy, in which all lung tissue on one side is removed, and (b) pulmonary resections involving less than the entire lung. In the latter procedure the simple effective principle of obtaining an expanded lung and an empty or obliterated pleural space can be achieved. In lobectomy or segmental resection, as long as the remaining lung is expanded it is an effective respiratory organ and a space-occupying mass. By expansion of the remaining lung tissue, by narrowing of the intercostal spaces, by elevation of the diaphragm, and by shifting of the mediastinum the pleural space is obliterated or emptied of air, fluid, or other material. Free surfaces are eliminated. There is intimate contact between the expanded lung and the tissues that make up the wall of the pleural cavity. With the elimination of free surfaces bac Lena that may be present are directly under the influence of inflammatory reaction, and, if present in the blood stream, antibodies, antibiotics, and chemotherapeutic agents are brought to the region of inflammation by the blood stream. Whether or not the amputated and sutured bronchial stump is covered by pleura or other living tissue is relatively unimportant, since obliteration of the pleural space will effectively surround the amputated closed bronchus by living tissue. In pneumonectomy, pleural space infection or pleural empyema is more likely to occur and it is a much more serious complication because there is no remaining lung tissue to expand on the operated side to obliterate the pleural space. If bacteria are present they have the advantage of growing in a fluid medium and of attacking a free surface. When bacteria are present upon or attack a free surface area they are not within living tissue. This gives them a great advantage over the body for they are outside the effectiveness of the nonspecific inflammatory reaction.3’ Similarly, since the bacteria are not within living tissue or surrounded by living cells they are outside the effective range of antibodies, antibiotics, and chemotherapeutic agents that can, if present in the blood stream, be brought into and concentrated in the tissues about the site of bacterial invasion. In pneumonectomy the amputated sutured bronchial

Study objective We evaluated treatment and outcome of patients with thoracic empyema at a teaching institution. Design and setting Retrospective chart review over a 44-month period at a university hospital. Patients and measurements Charts of patients with a hospital discharge diagnosis of thoracic empyema were reviewed. Age, symptoms, alcohol use, empyema etiology, culture results, number of loculations, date and success of each procedure, length of hospital stay, and hospital discharge status were recorded for each patient. Success of procedure, recovery time, time between procedures, and total hospitalization time were compared between procedures and between subgroups. Results Charts from 43 patients were reviewed. Twenty-four of 43 (56%) cases were parapneumonic empyemas. Forty of 43 (93%) patients had symptoms attributable to their empyema, with fever being the most common (65%). Seventy-nine procedures were needed to treat the 43 patients (1.84 procedures per patient). Success rates ranged from 11% (3/27) for tube thoracostomy to 95% (21/22) for decortication (p=0.0001). Delay between procedures averaged 6.2 ± 1.1 (mean ± SEM) days between the first and second procedure (n=27), and 10.4 ± 5.1 days between the second and third procedure (n=8). Mean recovery after successful intervention ranged from 9 to 19.3 days depending on the procedure (p=NS). Comparisons between multiloculated and uniloculated empyemas, parapneumonic and nonparapneumonic empyemas, and culture proven and biochemically proven empyemas showed no significant difference in procedure success rates or length of hospital stay. Conclusion Multiple therapeutic options exist for the treatment of thoracic empyema. Optimal therapy requires selection of the most appropriate first procedure for each patient with early postprocedure imaging to avoid inordinate delays between interventions.

We evaluated treatment and outcome of patients with thoracic empyema at a teaching institution.Retrospective chart review over a 44-month period at a university hospital.Charts of patients with a hospital discharge diagnosis of thoracic empyema were reviewed. Age, symptoms, alcohol use, empyema etiology, culture results, number of loculations, date and success of each procedure, length of hospital stay, and hospital discharge status were recorded for each patient. Success of procedure, recovery time, time between procedures, and total hospitalization time were compared between procedures and between subgroups.Charts from 43 patients were reviewed. Twenty-four of 43 (56%) cases were parapneumonic empyemas. Forty of 43 (93%) patients had symptoms attributable to their empyema, with fever being the most common (65%). Seventy-nine procedures were needed to treat the 43 patients (1.84 procedures per patient). Success rates ranged from 11% (3/27) for tube thoracostomy to 95% (21/22) for decortication (p = 0.0001). Delay between procedures averaged 6.2 +/- 1.1 (mean +/- SEM) days between the first and second procedure (n = 27), and 10.4 +/- 5.1 days between the second and third procedure (n = 8). Mean recovery after successful intervention ranged from 9 to 19.3 days depending on the procedure (p = NS). Comparisons between multiloculated and uniloculated empyemas, parapneumonic and nonparapneumonic empyemas, and culture proven and biochemically proven empyemas showed no significant difference in procedure success rates or length of hospital stay.Multiple therapeutic options exist for the treatment of thoracic empyema. Optimal therapy requires selection of the most appropriate first procedure for each patient with early postprocedure imaging to avoid inordinate delays between interventions.