High-pressure continuous suction drainage for thoracic empyema with pulmonary fistula

Background: The treatment of thoracic empyema with pulmonary fistula (PF) is challenging and involves administration of antibiotics and efficient drainage of pus. Open window thoracostomy (OWT) is typically offered for these cases, but it has several disadvantages, notably postoperative pain that is associated with rib resection. We described six consecutive cases of thoracic empyema with PF that were successfully treated with high-pressure continuous suction drainage (HCSD) instead of conventional OWT. Methods: Between January 2015 and December 2018, six consecutive patients (mean age of 65.0 years) with thoracic empyema and PF underwent HCSD treatment. Suction was initially set at −20 cmH 2 O and was increased incrementally up to −50 cmH 2 O with careful attention to any potential changes in the patients’ circulatory and respiratory dynamics. Results: All six patients were successfully treated with HCSD alone, and there were no related complications. The mean duration of air leakage was 57.2 days (range, 22–100 days). The drainage tubes were removed after a mean period of 60.2 days (range, 27–105 days). All patients were discharged from the hospital without later readmission. Conclusions: HCSD treatment was safe, minimally invasive, and effective for patients with thoracic empyema with PF and may be considered as an alternative treatment to OWT. 6