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2017, Number 1

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Cir Gen 2017; 39 (1)

Strategy in pleural and lung suppuration depending on the surgical risk

Mederos TOL, Mederos CON, Barrera OJC, Castellanos GJA, Romero DCA, Cruz CG

Language: Spanish
References: 19
Page: 7-12
PDF size: 193.45 Kb.


ABSTRACT

Introduction: The need to address complex, infectious thoracic problems with high-risk techniques on elderly patients increases the surgical risk. Objective: To describe the evolution of patients subjected to drainage of lung and pleura applying a strategy of surgical selection according to the surgical risk. Material and methods: A cross-sectional study of 139 patients was conducted, 75.5% with suppuration of pleura and 24.5% of lung, whose treatment was surgical. High-risk patients ASA III to IV were determined, with cardiovascular and respiratory disease. Results: Male patients and those 60 years and older dominated. In those ASA I and II, resection of the pulmonary suppuration and decortication of the pleura was performed more frequently; in those ASA III and IV, and high-risk, pneomostomy on the lung suppuration and the drainage with washing up and thoracic window in the pleura dominated, all under local anesthesia. Those submitted to major interventions were at 2.36 times greater risk of complication, with a weak negative correlation between hospital stay and the patient’s age; most complications were clinical, with low mortality rate. Conclusion: The implementation of a surgical strategy based on surgical risk proved to be an effective method for the treatment and outcome of the patients with lung and pleura suppuration.


REFERENCES

  1. Mederos Curbelo ON. Cirugía torácica. Comentarios de casos clínico-quirúrgicos. La Habana: Editorial de Ciencias Médicas; 2012. p. 129-143. ISBN: 978-959- 212-738-8.

  2. Bekele-Jembere B, Mederos-Curbelo ON, Valdés- Jiménez J, Barreras-Ortega JC, Romero-Díaz CA, Cantero-Ronquillo A. Manejo escalonado en la supuración pleural. Rev Cubana Cir. 2002; 41: 141- 146.

  3. Mederos-Curbelo ON, Del Campo-Abad R, Barreras- Ortega JC, Romero-Díaz C, Cantero-Ronquillo A, Hung-Chang C. Ventana torácica con anestesia local. Alternativa en el enfermo grave con empiema pleural. Rev Arch Cir Gen Dig [Internet]. 2005. © Cirugest. [Consultada el 15 de mayo de 2012]. Disponible en: http://www.cirugest.com/revista/2005/06/2005-03-21. htm

  4. Mederos-Curbelo ON, Olewasegun-Abiodun A, Mederos-Trujillo OL, Barrera-Ortega JC, Castellanos-González JA. Ventana torácica y anestesia local en la supuración pleural. Rev Cubana Cir [Internet]. 2016; 55. Disponible en: http://scielo. sld.cu/scielo.php?script=sci_arttext&pid=S0034- 74932016000100004&lng=es.

  5. Mederos-Curbelo ON, Barrera-Ortega JC, Castellanos- González JA, Romero-Díaz CA, Mederos-Trujillo OL. Neumostomía con sonda de balón en colecciones purulentas del pulmón. Rev Cubana Cir. 2014; 53: 145-155.

  6. Mederos-Curbelo ON, Barrera-Ortega JC, Cantero- Ronquillo A, Da Costa JM, Oliva-Anaya VC. La decorticación pulmonar en el empiema pleural. Rev Cubana Cir [Internet]. 2008; 47. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_ arttext&pid=S0034-74932008000300002&lng=es.

  7. Aurek W, Makarewicz W, Bobowicz M, Sawicka W, Rzyman W. The treatment of chronic pleural empyema with laparoscopic omentoplasty. Initial report. Wideochir Inne Tech Maloinwazyjne. 2014; 9: 548-553.

  8. Fuentes-Valdés E. Técnica de Monaldi para el tratamiento de abscesos pulmonares. Rev Cubana Cir [Internet]. 2010; 49. Disponible en: http://scielo. sld.cu/scielo.php?script=sci_arttext&pid=S0034- 74932010000200008&lng=es.

  9. Bartlett JG. How important are anaerobic bacteria in aspiration pneumonia: when should they be treated and what is optimal therapy. Infect Dis Clin North Am. 2013; 27: 149-155.

  10. Castillo-Aguilera MÁ, Mederos-Trujillo OL, Mederos- Curbelo ON. Descompensación diabética y lesión torácica ¿Absceso del pulmón? Revista de Portales Médicos.com [Internet]. 2011.

  11. Witzke H, Anikin V. Other conditions of the lung (abscesses, inhaled foreign bodies, bullous lung disease, hydatid). Surgery. 2014; 32: 261-265.

  12. Nie W, Liu Y, Ye J, Shi L, Shao F, Ying K, et al. Efficacy of intrapleural instillation of fibrinolytics for treating pleural empyema and parapneumonic effusion: a meta-analysis of randomized control trials. Clin Respir J. 2014; 8: 281-291.

  13. Guerra M, Neves PC, Martins D, Miranda J, Leal F, Vouga L. Surgery for thoracic empyema: personal experience and current highlights. Rev Port Cir Cardiotorac Vasc. 2012; 19: 21-26.

  14. Socci L, Marta HS, López MF. Treatment of postpneumonectomy empyema: goodbye to Clagett’s thoracostomy. Cir Esp. 2011; 89: 329-332.

  15. Shin JA, Chang YS, Kim TH, Haam SJ, Kim HJ, Ahn CM, et al. Surgical decortication as the first-line treatment for pleural empyema. J Thorac Cardiovasc Surg. 2013; 145: 933-939.

  16. Shipulin PP, Koziar ON, BaĬdan VV, Martyniuk VA, Severgin VE, Kiriliuk AA, et al. Application of early videothoracoscopic pulmonary decortication in the treatment of an acute pleural empyema and suppurated clotted hemothorax. Klin Khir. 2010; (10): 29-31.

  17. Arango-Tomás E, Cerezo-Madueño F, Algar-Algar FJ, Salvatierra-Velázquez A. Is lung surgery a good option for octogenarians? Cir Esp. 2014; 92: 615-618.

  18. Rodríguez M, Gómez MT, Jiménez MF, Aranda JL, Novoa N, Varela G. The risk of death due to cardiorespiratory causes increases with time after right pneumonectomy: a propensity score-matched analysis. Eur J Cardiothorac Surg. 2013; 44: 93-97.

  19. Søgaard M, Nielsen RB, Nørgaard M, Kornum JB, Schønheyder HC, Thomsen RW. Incidence, length of stay, and prognosis of hospitalized patients with pleural empyema: a 15-year Danish nationwide cohort study. Chest. 2014; 145: 189-192.




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