EMPYEMA

Empyema
An accumulation of
thick, purulent fluid within
the pleural space, often
with fibrin development
Causes/Risk Factors
Presence of bacterial pneumonia
or lung abscess
Penetrating chest trauma
Hematogenous infection of the
pleural space
Iatrogenic causes (after thoracic
surgery or thoracentesis)
 ORGANISMS
Staphylococcus aureus, Streptococcus
pneumoniae and Streptococcus pyogenes
 Pathophysiology
Presence of Parapneumonic
Effusion

Release of inflammatory
mediators


permeability of the capilliaries

Attracts WBCs to the site

Escape of albumin & other
protein from the capillaries


Pleural fluid

Presence of free-flowing, protein

rich pleural fluid
(Stage I)


Inflammation worsens

Attracts more WBCs to the

site


Extensive purulent exudate production

Initiation of fibroblastic activity

(Stage II)


Adherence of the two pleural
membranes
(Stage III)

Formation of a peell
 Stages of Empyema
Exudative stage (1-3 days )

Fibrino purulent stage (4 to 14 days)

Organizing stage (after 14 days)

 Exudative stage (1-3
days)
Immediate response with outpouring
of the fluid.
Low cellular content
It is simple parapneumonic effusion
with normal pH and glucose levels.
 Fibrino purulent stage (4 to 14 days)
Large number of poly-morphonuclear
leukocytes and fibrin accumulates
Acumulation of neutro-phils and fibrin,
effusion becomes purulent and viscous
leading to development of empyema.
 Organizing stage (after 14 days)
Fibro-blasts grow into exudates on both
the visceral and parietal pleural surfaces
Development of an inelastic membrane
"the peel".
Most common in S. aureus infection.
Thickened pleural peel can restrict lung
movement and it is commonly termed as
trapped lung
 DIAGNOSIS
LAB INVESTIGATIONS
CBC count
Blood culture
Serum LDH
Total protein
Bacterial, mycobacterial, and fungal cultures
 X-RAY
Large pleural effusion can be diagnosed in
posteroanterior view
Lateral decubitus view with affected side
inferior facilitates recognition of smaller
volumes of fluid.
oSonography or CT imaging

o Chest CT imaging to detect :

- pleural fluid and image the
airways
- guide interventional procedures
 CLINICAL MANIFESTATIONS

o Like bacterial pneumonia

o Acute febrile response, pleuritic
chest pain, cough, dyspnea, and
possibly cyanosis
o Abdominal pain, vomiting
o Splinting of the affected side

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 TREATMENT
Control of the infection
Drainage of the pleural fluid
Appropriate antibiotic : 10-14 days / IV
Oxygen
Oral antibiotics for 1-3 weeks after
discharge if complicated infections (+)

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 ANTIBIOTICS

Cefuroxime = 150 mg/kg/day (: 3 dose)

Clyndamycin = 25 40 mg/kg/day (: 3
dose)
Good most patients recover without sequelae

Early recognition initiation of definitive

therapy reduce morbidity and complications

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THORACENTESIS
 Nursing Diagnosis
Impaired Gas Exchange r/t
compressed lung
Acute Pain r/t infection of the
pleura
Risk for Activity Intolerance r/t
hypoxia secondary to empyema