AATS Guidelines: Evidence-based Empyema Management

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Surgery remains the most effective method for management of most patients with empyema.
Surgery remains the most effective method for management of most patients with empyema.

The American Association for Thoracic Surgery (AATS) has released evidence-based guidelines for the management of empyema. The full guidelines can be found in The Journal of Thoracic and Cardiovascular Surgery

Empyema, an accumulation of pus around the lungs, typically occurs as a complication of pneumonia. To improve management of this disease, the Guidelines Working Group reviewed the latest data on empyema to develop new evidence-based clinical guidelines. 

The guidelines include information on disease presentation, diagnosis, and treatment.

Some of the key recommendations include:

  • Patients with pneumonia that fail to respond to established antibiotics or unexplained sepsis should always be evaluated for a possible pleural effusion.
  • If either a parapneumonic effusion or empyema is found, patients should undergo immediate treatment.
  • Surgery remains the most effective method for management of most patients with empyema despite advances in radiologic imaging, antibiotics, and other drugs that have made it possible to treat without undergoing surgery.
  • Pediatric patients with empyema should initially be treated with a tube thoracostomy with or without the subsequent instillation of fibrinolytic agents.

Lead author K. Robert Shen, MD, from the Mayo Clinic College of Medicine, Rochester, MN, added, "These new guidelines formulated by the AATS are important because they represent an attempt to develop recommendations that are based upon the best available current scientific evidence." Experts in the Working Group hope these guidelines will help clinicians who care for pneumonia patients to best treat those who develop empyema.

Reference

Shen KR, Bribriesco A, Crabtree T, et al. The American Association for Thoracic Surgery consensus guidelines for the management of empyema [published online February 4, 2017]. J Thorac Cardiovasc Surg. doi: 10.1016/j.jtcvs.2017.01.030

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