Empyema

1. EMPYEMA

2. Empyema
An accumulation of
thick, purulent fluid within
the pleural space, often
with fibrin development

3. 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)

4. ORGANISMS
• Staphylococcus aureus, Streptococcus
pneumoniae and Streptococcus pyogenes

5. Presence of Parapneumonic
Effusion

Release of inflammatory
mediators

Pathophysiology

6. 
↑permeability of the capilliaries
 
Attracts WBCs to the site
Escape of albumin & other
protein from the capillaries


7. 
↑ Pleural fluid

Presence of free-flowing, protein
rich pleural fluid
(Stage I)


8. 
Inflammation worsens

Attracts more WBCs to the
site


9. 
Extensive purulent exudate production

Initiation of fibroblastic activity
(Stage II)


10. 
Adherence of the two pleural
membranes
(Stage III)

Formation of a “peell”

11. Stages of Empyema
• Exudative stage (1-3 days )
• Fibrino purulent stage (4 to 14 days)
• Organizing stage (after 14 days)

12. 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.

13. 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.

14. 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

15. DIAGNOSIS
LAB INVESTIGATIONS
• CBC count
• Blood culture
• Serum LDH
• Total protein
• Bacterial, mycobacterial, and fungal cultures

16. 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.

17. oSonography or CT imaging
o Chest CT imaging to detect :
- pleural fluid and image the
airways
- guide interventional procedures

19. 19
CLINICAL MANIFESTATIONS
oLike bacterial pneumonia
oAcute febrile response, pleuritic
chest pain, cough, dyspnea, and
possibly cyanosis
oAbdominal pain, vomiting
oSplinting of the affected side

20. 20
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 (+)

21. 21
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

22. THORACENTESIS

23. 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