Treatment of Postpneumonectomy Empyema with Debridement Followed by Continuous Antibiotic Irrigation
Bibliographic record
Abstract
BACKGROUND: The goal of this study was to determine the efficacy of treating postpneumonectomy empyema (PPE) with debridement followed by continuous antibiotic irrigation for pneumonectomy space sterilization. STUDY DESIGN: All patients presenting with PPE were evaluated. Patients with bronchopleural fistula (BPF) underwent thoracotomy for fistula closure and debridement. Patients without BPF underwent video-assisted thoracic surgery debridement. All patients then underwent intraoperative placement of an 8-F irrigation catheter and a 36-F drainage catheter. Two weeks of continuous antibiotic irrigation, as determined by cultures, were followed by collection of chest cultures on 3 consecutive days. If cultures returned negative, antibiotic was instilled into the chest and all catheters were removed. If cultures were positive, another 2 weeks of irrigation were reinitiated, adjusting the antimicrobial agent based on culture results. This regimen was repeated until three consecutive negative cultures were obtained. RESULTS: Over a 5-year period, 8 consecutive patients with PPE were evaluated. Two had BPF. Mean age was 56 years. Median time to empyema after pneumonectomy was 20 days (range 12 to 497 days). Mean irrigation duration was 40 days (range 18 to 72 days) and mean followup was 580 days (range 75 to 1,666 days). There was no treatment-associated morbidity or mortality. No patients experienced empyema recurrence during followup. CONCLUSIONS: PPE can be successfully treated with thoracic debridement followed by continuous antibiotic irrigation. This method avoids the morbidity of rib resection or thoracic cavity reduction procedures. Closure of BPF, if present, is a prerequisite. Debridement can be performed by video-assisted thoracic surgery in patients without fistula.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".