Clinical Challenges in Thoracic Surgery: Complex Pleural Effusions & Empyema - Part 1 of 2

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 14 August 2023

⏱️ 29 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

In this two-part episode our team debates management of complex pleural effusions and empyema. Our surgical team is joined by Dr. Jed Gorden, an interventional pulmonologist, as we explore the nuances of deciding on fibrinolytic therapy (part 1) versus surgical management (part 2).

Learning Objectives:

-Discuss the pros and cons of small bore versus large bore chest tubes for complex pleural effusions
-Review the evidence for fibrinolytic therapy for management of complex pleural effusions
-Describe the surgical management of a complex pleural effusion including VATS, open thoracotomy, empyema tube, Eloesser flap, and Clagett window
-Create a framework for shared-decision making with patients regarding management of a complex pleural effusion

Hosts:

Kelly Daus MD, Peter White MD, Jed Gorden, MD and Brian Louie MD

Referenced Material

https://pubmed.ncbi.nlm.nih.gov/15745977/
Maskell NA, et al. First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3;352(9):865-74. doi: 10.1056/NEJMoa042473. Erratum in: N Engl J Med. 2005 May 19;352(20):2146. PMID: 15745977.

https://pubmed.ncbi.nlm.nih.gov/21830966/
Rahman NM, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011 Aug 11;365(6):518-26. doi: 10.1056/NEJMoa1012740. PMID: 21830966.

https://pubmed.ncbi.nlm.nih.gov/35830586/
Wilshire CL, et al. Comparing Initial Surgery versus Fibrinolytics for Pleural Space Infections: A Retrospective Multicenter Cohort Study. Ann Am Thorac Soc. 2022 Nov;19(11):1827-1833. doi: 10.1513/AnnalsATS.202108-964OC. PMID: 35830586.

https://pubmed.ncbi.nlm.nih.gov/37043201/
Wilshire CL, et al. Effect of Intrapleural Fibrinolytic Therapy vs Surgery for Complicated Pleural Infections: A Randomized Clinical Trial. JAMA Netw Open. 2023 Apr 3;6(4):e237799. doi: 10.1001/jamanetworkopen.2023.7799. PMID: 37043201; PMCID: PMC10098968.

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

If you liked this episode, check out more thoracic surgery episodes here: https://behindtheknife.org/podcast-category/cardiothoracic/

Transcript

Click on a timestamp to play from that location

0:00.0	Behind the Night, the Surgery Podcast.
0:09.0	Relevant and engaging content designed to help you dominate the day.
0:13.0	Hello everyone and welcome back to another podcast with your Swedish thoracic surgery team.
0:29.0	I'm your host Kelly Dawes and today we're excited to share a clinical challenge with you about one of our favorite topics to debate here as a team.
0:38.0	When faced with a complex peripheral effusion or impagema, should we book the patient for a vat's decordication or should we trial a non operative management with lytic therapy?
0:50.0	This topic was just way too exciting to fill a single episode.
0:55.0	So enjoy part one in which we discuss predominantly managing these complex peripheral effusions with lytic therapy followed by part two where we dive deeper into the surgical management of these complex peripheral effusions.
1:11.0	We hope you enjoy.
1:14.0	Welcome to part one of our clinical challenges in thoracic surgery, complex peripheral effusions and impagema.
1:22.0	Before we dive in, we want to share a quick update on one of our prior episodes, which discussed the adura trial.
1:29.0	Recall that this trial looked at adjuvant osumurtinib versus placebo in EGFR mutated stage 1B to 3A non-small cell lung cancer.
1:41.0	They just presented their five-year survival data at ASCO in June.
1:46.0	We covered their initial analysis on our journal review adjuvant therapy in the lung adenocarcinola in November of 2021.
1:54.0	We discussed how their initial data demonstrated excellent disease-free survival.
2:00.0	While now at ASCO, they presented their data that shows osumurtinib versus placebo also improves overall survival with the hazard ratio of point 49.
2:12.0	Keep on the lookout for the paper as it should be published later this year.
2:16.0	Now let's dive in to part one of our clinical challenges, complex peripheral effusions and impagemas.
2:24.0	Here to take us through our clinical challenge today, we have Dr. Brian Louis.
2:29.0	Howdy, dude.
2:30.0	Dr. Peter White.
2:32.0	Hi.
2:33.0	And joining us for the first time as a guest at our podcast today, we have Dr. Jed Gordon.
	...

Please login to see the full transcript.

Previous episode | Next episode

Disclaimer: The podcast and artwork embedded on this page are from Behind The Knife: The Surgery Podcast, and are the property of its owner and not affiliated with or endorsed by Tapesearch.

Generated transcripts are the property of Behind The Knife: The Surgery Podcast and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.