Medical Thoracoscopy in Treatment Outcomes of Empyema Management

Study Overview
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Brief Summary
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To evaluate the efficacy of drainage achieved by thoracoscopy vs tube drainage alone. To compare clinical outcomes such as length of hospital stay, need for additional procedures, and treatment failure rates between the two drainage methods. To asses resolution of pleural infection and rates of fluid re-accumulation over follow-up. To compare safety profiles and complication rates of thoracoscopy versus tube drainage alone

Detailed Description
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Empyema is a serious infection characterized by pus accumulation in the pleural space. Effective drainage and treatment is necessary for resolution. Traditionally, intercostal tube placement was standard initial management. However, recent studies have compared outcomes of early medical thoracoscopy or video-assisted thoracoscopic surgery (VATS). Thoracoscopy enables direct visualization for thorough pleural space cleansing and debridement under direct vision. medical thoracoscopy significantly improved drainage adequacy and reduced treatment failure risks compared to tube drainage alone. Also reported shorter hospital stays and lower complication rates with early thoracoscopy-directed management. Additional benefits of thoracoscopy include enabling talc pleurodesis for reducing empyema recurrence. thoracoscopy-directed pleurodesis achieved higher long-term success rates than tube drainage followed by pleurodesis. Overall, current evidence indicates medical thoracoscopy provides superior empyema treatment outcomes to conventional tube drainage through optimized drainage and debridement under direct visualization.

Official Title
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Medical Thoracoscopy Versus Conventional Intercostal Tube in Treatment Outcomes of Empyema Management

Conditions
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Empyema

Intervention / Treatment
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* Procedure: Thoracoscopy procedure
* Procedure: Chest tube thoracostomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Confirmed diagnosis of empyema via Imaging tests (e.g. chest x-ray/CT scan) Age 18 years or older Clinical signs/symptoms consistent with Empyema such as fever, chest pain, coughs Pleural fluid loculations/septations seen on Imaging requiring drainage No previous drainage procedures done for Current empyema Exclusion Criteria: Age less than 18 years Immunocompromised state or other conditions Contraindications to thoracoscopy Previous drainage procedure for current Empyema Residual pleural fluid not amenable to drain

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Medical thoracoscopy group
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Medical thoracoscopy group<br>Medical thoracoscopy is a minimally invasive endoscopic procedure utilized by pulmonologists to evaluate, diagnose, and treat pleural pathologies of the lung, mainly pleural effusions. | Procedure: Thoracoscopy procedure<br>* is a minimally invasive endoscopic procedure utilized by pulmonologists to evaluate, diagnose, and treat pleural pathologies of the lung, mainly pleural effusions.<br>Procedure: Chest tube thoracostomy<br>* Insert chest intercostal tube without thoracoscopy<br>|
| Active Comparator: Intercostal tube group<br>Intercostal chest tube placed without thoracoscopy for patients with confirmed empyema. | Procedure: Thoracoscopy procedure<br>* is a minimally invasive endoscopic procedure utilized by pulmonologists to evaluate, diagnose, and treat pleural pathologies of the lung, mainly pleural effusions.<br>Procedure: Chest tube thoracostomy<br>* Insert chest intercostal tube without thoracoscopy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Treatment success: | Asses by chest ultrasound | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Success of pleurodesis | measured by assessing the recurrence rate of pleural effusion over a specified follow-up period. | baseline |