What are the treatment principles for acute empyema?

Many children currently present with symptoms of empyema; however, clinicians are often uncertain about the appropriate treatment principles. What, then, are the treatment principles for acute empyema?

What Are the Treatment Principles for Acute Empyema?

The treatment principles for acute empyema are as follows: First, perform closed thoracic drainage to ensure adequate evacuation of pleural fluid. If necessary, irrigate the pleural cavity to facilitate complete removal of purulent material. Perform culture and antimicrobial susceptibility testing of the pus to guide selection of appropriate, targeted antibiotics. The duration of antibiotic therapy must be sufficient—typically 3–4 weeks—to achieve complete resolution. Monitor blood counts and C-reactive protein (CRP) levels regularly during treatment. Ensure adequate nutritional support, as empyema is a catabolic condition that leads to hypoalbuminemia and diminished immune function; therefore, sufficient caloric and protein intake is essential.

Empyema refers to a purulent infection characterized by accumulation of purulent exudate within the pleural cavity. When the disease duration is less than three months, it is classified as acute empyema. Key considerations for thoracentesis in acute empyema include performing the procedure under ultrasound guidance, with the puncture site selected at the lowest point of the empyema cavity or at the eighth or ninth intercostal space along the posterior axillary line. The needle should be inserted just above the upper border of the rib to avoid injury to the intercostal vessels. Each aspiration should aim for complete evacuation of pus; at the conclusion of aspiration, a suitable dose of antibiotics should be instilled directly into the pleural cavity. Thoracentesis should be repeated every two to three days until all pus has been drained, infection is controlled, and lung re-expansion is achieved. If large volumes of pus persist and repeated aspirations fail to control the infection, prompt transition to closed thoracic drainage is indicated.