For patients with poor results of repeated thoracentesis, severe toxic symptoms, mixed infection, obvious cardiopulmonary compression symptoms and combined bronchopleural fistula, closed chest drainage should be performed to drain the pus as soon as possible, reduce toxic symptoms, prevent the spread of tuberculosis lesions, relieve cardiopulmonary compression symptoms, and make the compressed lung reopen in time. It can also create conditions for the necessary radical surgery. Wang Cheng, Department of Thoracic Surgery, Shandong Provincial Chest Hospital
For a small number of patients with tuberculous abscess chest who are old, poor in health and have serious symptoms of poisoning and cannot tolerate further surgery, closed drainage of the chest cavity can not only quickly relieve the symptoms of poisoning and stop further development of the disease but also serve as a permanent treatment method.
Patients with tuberculosis lesions breaking into the thoracic cavity resulting in tuberculous abscess chest are often accompanied by mixed infections and active lesions in the lungs, and the lesions in the lungs are often directly connected with the abscess cavity, which is not easy to heal and prone to haemoptysis and even the risk of asphyxia. These patients should be treated with closed chest drainage in a timely manner. Drainage can reduce the patient’s severe cough symptoms, help prevent pulmonary and bronchial spread or control pulmonary infection; reduce the symptoms of systemic tuberculosis intoxication, improve the patient’s physical condition, reduce the pus cavity, and avoid the occurrence of pulmonary atelectasis. Surgery can be considered only when the intrapulmonary tuberculosis lesions tend to be stable, and for irreversible lesions in the lung, they can be removed together with surgery.
For patients with reversible intrapulmonary lesions combined with bronchopleural fistulas who are to undergo thoracoplasty, drainage should be performed first to improve the patient’s systemic symptoms, followed by lesion removal-fistula repair-dirty fiberboard debridement, and then adequate and effective drainage. Closed thoracic drainage cleanses the abscess cavity, controls the infection, and serves to regulate intrathoracic pressure. On the one hand, under the long-term chronic stress of respiratory movement, the lung slowly re-expands and the residual cavity slowly decreases, and on the other hand, the slow re-expansion of the lung prevents the spread of tuberculosis foci due to rapid expansion of lung tissue. On the other hand, the slow re-expansion of the lung can avoid the spread of tuberculosis foci due to rapid expansion of lung tissue. The purpose of controlling infection and reducing the residual cavity can be achieved, and the lung function can be preserved to the maximum extent, and the postoperative deformity brought by thoracoplasty can be avoided or reduced.
The key to successful drainage of abscess chest is that the drainage site should be at the bottom of the abscess cavity but not too low. If the placement site is too low, the diaphragm is easily injured or the drainage tube is misplaced under the diaphragm in the process of placement, the drainage tube should be thick enough, the removal of corrupted tissue should be thorough, the position of the drainage tube should be adjusted when poor drainage is found, the abscess cavity should be probed and the internal fiber separation should be bluntly separated, which is conducive to improving drainage.
After performing closed chest drainage, the patient should be encouraged to cough and practice deep breathing mainly by inspiration; encourage the patient to move more out of bed to promote lung expansion to reduce or eliminate the residual cavity; pay attention to the nature of drainage fluid and daily changes in drainage flow, changes in the pus cavity and lung expansion; observe whether the drainage position is appropriate and whether the drainage is unobstructed, and adjust it in time if necessary.
From: Wang Cheng, Jin Feng, et al. “The role of closed chest drainage in the treatment of tuberculous abscess chest”, published in China General Clinical, 2007, 23(11): 1023-1024