Intrapleural irrigation with electrolyzed saline for acute empyema

Kembu Nakamoto., Motohiro Takeshige., Toshiyuki Fujii., Hiroshi Hashiyada., Kazuya Yoshida and Kazuhiro Ootsubo

Background: The bactericidal activity of electrolyzed saline (ES), a novel disinfectant, was preliminary reported in the acute empyema. The efficacy of intrapleural ES irrigation against empyema was evaluated.

Methods: A retrospective study of fifty-four patients with parapneumonic empyema from 2005to 2016. Twenty-eight patients had ES irrigation under miniaturized thoracoscopic surgery or indwelled catheter (ES group). The remaining 26 patients had catheter drainage with or without saline irrigation (Control group). End points were disease cure, hospital discharge or prognosis at 5 months across subgroups defined by patients characteristics, disease severity, and treatment procedures.

Results: Most pathogens were oral microflora. None in the ES group had subsequent surgical options, whereas five in the control group were followed by surgical options. Clinical features were promptly improved in the ES group. Mean catheter indwelling periods in the ES and control groups were12.3±10.0 and23.9±19.7days (p=0.0080), respectively. Disease cure rates were 89.3% with 9-dayand 50.0% with 34-day half-cure periods, respectively, with significant improvements in the ES group (p<0.001). The midpoint of hospital stay and mortality in both groups were37 and 77days (p= 0.0496), and 14.3 and 42.3% (p= 0.0216), respectively. The disease free survival rates at5months were 75.4% and 45.0% (p=0.0066), respectively. Intrapleural ES irrigation was a significant contributor for outcome improvements of parapneumonic empyema, while age, comorbidities, bronchofistula, and disease extensions were other prognostic limitations under multivariable analysis.

Conclusions: ES irrigation was an effective and minimally invasive strategy for rapid cure of empyema.

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