Medical Thoracoscopy in Treatment Outcomes of Empyema Management

Hend Mohamed Sayed Mohamed

Status: Not yet enrolling

Conditions: Empyema

Treatments: Procedure: Thoracoscopy procedure; Procedure: Chest tube thoracostomy

Study type: Interventional

Funder types: Other

Identifiers

NCT06132997

Medical thoracoscopy&Empyem

Details and patient eligibility

About

To evaluate the efficacy of drainage achieved by thoracoscopy vs tube drainage alone.

To compare clinical outcomes such as length of hospital stay, need for additional procedures, and treatment failure rates between the two drainage methods.

To asses resolution of pleural infection and rates of fluid re-accumulation over follow-up.

To compare safety profiles and complication rates of thoracoscopy versus tube drainage alone

Full description

Empyema is a serious infection characterized by pus accumulation in the pleural space. Effective drainage and treatment is necessary for resolution. Traditionally, intercostal tube placement was standard initial management. However, recent studies have compared outcomes of early medical thoracoscopy or video-assisted thoracoscopic surgery (VATS).

Thoracoscopy enables direct visualization for thorough pleural space cleansing and debridement under direct vision. medical thoracoscopy significantly improved drainage adequacy and reduced treatment failure risks compared to tube drainage alone. Also reported shorter hospital stays and lower complication rates with early thoracoscopy-directed management.

Additional benefits of thoracoscopy include enabling talc pleurodesis for reducing empyema recurrence. thoracoscopy-directed pleurodesis achieved higher long-term success rates than tube drainage followed by pleurodesis. Overall, current evidence indicates medical thoracoscopy provides superior empyema treatment outcomes to conventional tube drainage through optimized drainage and debridement under direct visualization.

Enrollment: 100 estimated patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Confirmed diagnosis of empyema via Imaging tests (e.g. chest x-ray/CT scan)
• Age 18 years or older
• Clinical signs/symptoms consistent with Empyema such as fever, chest pain, coughs
• Pleural fluid loculations/septations seen on Imaging requiring drainage
• No previous drainage procedures done for Current empyema

Exclusion criteria

• Age less than 18 years
• Immunocompromised state or other conditions Contraindications to thoracoscopy
• Previous drainage procedure for current Empyema
• Residual pleural fluid not amenable to drain

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

100 participants in 2 patient groups

Medical thoracoscopy group

Active Comparator group

Description:

Medical thoracoscopy is a minimally invasive endoscopic procedure utilized by pulmonologists to evaluate, diagnose, and treat pleural pathologies of the lung, mainly pleural effusions.

Treatment:

Procedure: Thoracoscopy procedure

Procedure: Chest tube thoracostomy

Intercostal tube group

Active Comparator group

Description:

Intercostal chest tube placed without thoracoscopy for patients with confirmed empyema.

Treatment:

Procedure: Thoracoscopy procedure

Procedure: Chest tube thoracostomy