Surgery versus intrapleural fibrinolysis for management of complicated pleural infections: a systematic review and meta-analysis.

IF 5.8 2区医学 Q1 Medicine Respiratory Research Pub Date : 2024-08-24 DOI:10.1186/s12931-024-02949-1

Jaewon Chang, Ben Indja, Jesse King, Stephanie Chan, Campbell D Flynn

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Abstract

Background: Complicated pleural infection comprises of complex effusions and empyema. When tube thoracostomy is ineffective, treatment options include surgical drainage, deloculation and decortication or intrapleural fibrinolysis. We performed a systematic review and meta-analysis to examine which technique is superior in treating complicated pleural infections.

Methods: PubMed, MEDLINE and EMBASE databases were searched for studies published between January 2000 to July 2023 comparing surgery and intrapleural fibrinolysis for treatment of complicated pleural infection. The primary outcome was treatment success. Secondary outcomes included hospital length of stay, chest drain duration and in-hospital mortality.

Results: Surgical management of complicated pleural infections was more likely to be successful than intrapleural fibrinolysis (RR 1.18; 95% CI 1.02, 1.38). Surgical intervention group benefited from statistically significant shorter hospital length of stay (MD: 3.85; 95% CI 1.09, 6.62) and chest drain duration (MD: 3.42; 95% CI 1.36, 5.48). There was no observed difference between in-hospital mortality (RR: 1.00; 95% CI 0.99, 1.02).

Conclusion: Surgical management of complicated pleural infections results in increased likelihood of treatment success, shorter chest drain duration and hospital length of stay in the adult population compared with intrapleural fibrinolysis. In-hospital mortality did not differ. Large cohort and randomized research need to be conducted to confirm these findings.

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手术与胸膜内纤维蛋白溶解术治疗复杂性胸膜感染：系统综述与荟萃分析。

背景：并发胸膜感染包括复杂的积液和肺水肿。当管道胸腔造口术无效时，治疗方案包括手术引流、脱位和去骨瓣或胸膜内纤维蛋白溶解术。我们进行了一项系统性回顾和荟萃分析，以研究哪种技术在治疗复杂性胸膜感染方面更具优势：方法：我们在 PubMed、MEDLINE 和 EMBASE 数据库中检索了 2000 年 1 月至 2023 年 7 月间发表的比较手术和胸膜腔内纤维蛋白溶解术治疗复杂性胸膜感染的研究。主要结果为治疗成功率。次要结果包括住院时间、胸腔引流时间和院内死亡率：结果：与胸膜腔内纤维蛋白溶解术相比，手术治疗复杂性胸膜感染的成功率更高（RR 1.18；95% CI 1.02，1.38）。手术干预组的住院时间（MD：3.85；95% CI：1.09-6.62）和胸腔引流时间（MD：3.42；95% CI：1.36-5.48）明显短于手术干预组。院内死亡率无差异（RR：1.00；95% CI 0.99，1.02）：结论：与胸膜腔内纤维蛋白溶解术相比，手术治疗复杂性胸膜感染可增加治疗成功的可能性，缩短胸腔引流时间和成人住院时间。院内死亡率没有差异。需要进行大规模的队列和随机研究来证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Respiratory Research RESPIRATORY SYSTEM-

CiteScore

9.70

自引率

1.70%

发文量

314

审稿时长

4-8 weeks

期刊介绍： Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.