A randomized trial of empyema therapy

Chest. 1997 Jun;111(6):1548-51. doi: 10.1378/chest.111.6.1548.


Study objectives: To determine the optimal treatment of empyema thoracis (within the fibrinopurulent phase of illness) comparing pleural drainage and fibrinolytic therapy vs video-assisted thoracoscopic surgery (VATS), with regard to efficacy and duration of hospitalization.

Design: Twenty patients with confirmed parapneumonic empyema thoracis were randomized to chest tube pleural drainage plus streptokinase (CT-SK) vs VATS.

Setting: University-based teaching hospital providing for Dallas County.

Patients and methods: Equivalent groups of patients with parapneumonic empyema thoracis were randomized to receive either of two therapies: CT-SK (n=9) or VATS (n=11). Outcomes analysis with respect to treatment efficacy, hospital duration, chest tube duration, hospital costs, and need for subsequent procedures was performed.

Results: Each group suffered one mortality (p=not significant). When compared with the CT-SK group, the VATS group had a significantly higher primary treatment success [10/11, 91% vs 4/9, 44%; p<0.05 Fisher's Exact Test], lower chest tube duration (5.8+/-1.1 vs 9.8+/-1.3 days; p=0.03), and lower number of total hospital days (8.7+/-0.9 vs 12.8+/-1.1 days; p=0.009). Clinically relevant but not statistically significant differences in hospital costs ($16,642+/-2,841 vs $24,052+/-3,466, p=0.11) also favored the VATS group. Of note, all the CT-SK treatment failures could be salvaged with VATS, and none required thoracotomy.

Conclusions: In patients with loculated, complex fibrinopurulent parapneumonic empyema thoracis, a primary treatment strategy of VATS is associated with a higher efficacy, shorter hospital duration, and less cost than a treatment strategy that utilizes catheter-directed fibrinolytic therapy.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Chest Tubes
  • Combined Modality Therapy
  • Drainage
  • Empyema, Pleural / surgery*
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Humans
  • Male
  • Middle Aged
  • Streptokinase / administration & dosage
  • Thoracoscopy
  • Treatment Outcome
  • Video Recording


  • Fibrinolytic Agents
  • Streptokinase