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(Chest. 1999;116:1703-1708.)
© 1999 American College of Chest Physicians

The Utility of Daily Therapeutic Thoracentesis for the Treatment of Early Empyema*

Scott Sasse, MD, FCCP; Tan Nguyen, MD; Lisete R. Teixeira, MD and Richard Light, MD, FCCP

* From the Pulmonary Disease Division, Department of Veterans Affairs Medical Center (Drs. Sasse, Nguyen, and Teixeira), Long Beach, CA; and Saint Thomas Hospital and Vanderbilt University (Dr. Light), Nashville, TN.

Correspondence to: Richard W. Light, MD, FCCP, Director of Pulmonary Disease Program, Saint Thomas Hospital, PO Box 380, 4220 Harding Rd, Nashville, TN

Study objectives: To determine if therapeutic thoracentesis is as effective as early chest tube placement or no drainage procedure in the treatment of early empyema in rabbits.

Design and interventions: An empyema, as evidenced by gross pleural pus and a decreased pleural fluid pH and glucose level, was induced in 49 rabbits. The rabbits were divided into three groups: 16 underwent daily therapeutic thoracentesis starting at 48 h, 14 underwent chest tube placement at 48 h, and 19 served as controls.

Results: The mortality rate in the therapeutic thoracentesis group (0/16) did not differ significantly from that in the chest tube group (3/14) or that in the control group (6/19). At autopsy at 10 days, the gross empyema score in the therapeutic thoracentesis group (2.1 ± 0.3) was significantly lower (p < 0.05) than that in the chest tube group (2.8 ± 0.3) or the control group (3.5 ± 0.2). The mean pleural peel score of 5.8 ± 1.1 in the therapeutic thoracentesis group was significantly less (p < 0.05) than the score for the nonintervention control group (13.4 ± 1.6).

Conclusions: From this study, we conclude that therapeutic thoracentesis is at least as effective as early chest tube placement for the treatment of early empyema using our rabbit model of empyema.

Key Words: chest tubes • empyema • parapneumonic effusion • thoracentesis




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