Saline lavage effective for management of severe pleural empyema, Finds study
Despite advances in the treatment of pleural infection, up to 20% of patients die. Case reports suggest that irrigation of the pleural space with saline may be beneficial. So far, studies assessing the role of intrapleural saline lavage for the management of all stage pleural infections are very scarce, usually excluding patients with cancer.
Therefore, researchers from the Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, (Marseille, France) have recently found out that intrapleural saline lavage is efficient and safe for the management of pleural empyema.
Literature review highlights that saline irrigation improves pleural fluid drainage and reduces referrals for surgery in pleural infection.
The study is published in the Clinical Respiratory Journal.
The authors carried out a retrospective cohort study including pleural empyema managed with a pleural lavage of saline solution through a small-bore chest tube.
The primary outcome was the rate of failure at 3 months (surgical referral or additional pleural manoeuver due to recurrent infection or all-cause mortality). Secondary outcomes were hospital stay, the change of the chest radiograph and inflammatory biomarkers, and complications.
The study revealed the following findings-
a. Thirty patients with pleural empyema were included with among them eleven (36.7%) with an active cancer.
b. The overall rate of failure at 3 months was 13.3% (surgical referral=0; additional pleural manoeuver=3; mortality=1).
c. Median length of pleural lavage and hospital stay were respectively 14 days (7-28) and 17 days (11-42).
d. Inflammatory markers and size of the effusion on chest radiograph significantly decreased for day 0 to day 14.
e. No chest tube blockade was reported, but 7 (23.3%) accidentally withdrew.
f. No other side effects were reported.
This led the authors to conclude that intrapleural saline lavage is efficient and safe for the management of pleural empyema, even in severe status patients with cancer, at the cost of a prolonged hospitalization.