From the Guidelines
When VATS is unsuccessful for decortication in cases of trapped lung, the recommended approach is to use an Indwelling Pleural Catheter (IPC) as it has been shown to provide symptomatic relief in >94% of patients 1. The decision to use an IPC is based on the evidence that it can effectively manage trapped lung, with studies showing improved dyspnoea-free exercise scores and higher effusion control rates compared to other treatments such as talc pleurodesis 1. Some key points to consider when using an IPC for trapped lung include:
- IPCs can be effective in providing symptomatic relief, with >94% of patients experiencing improvement 1
- The use of IPCs can result in shorter length of stay compared to other treatments such as VATS talc poudrage 1
- Serious adverse events such as empyema, IPC blockage, and catheter fracture can occur, but are relatively rare 1
- The evidence for other approaches such as surgical decortication and intra-pleural fibrinolytic therapy is limited, and IPCs are currently the preferred treatment for trapped lung 1. The use of IPCs in trapped lung is supported by several studies, including a systematic review that concluded IPCs are indicated in trapped lung 1. While surgical decortication may be considered in some cases, the current evidence suggests that IPCs are a more effective and safer treatment option for trapped lung 1.
From the Research
Approach for Decortication in Cases of Trapped Lung
When VATS is unsuccessful, the approach for decortication in cases of trapped lung may involve:
- Open thoracotomy for decortication, as VATS decortication may not be effective in all cases, particularly in chronic empyema cases 2
- Conversion to open thoracotomy, which may be required in some cases where VATS decortication is not successful 3, 2
- Uniportal VATS approach, which can be used for treatment of empyema, including debridement and decortication, and may be a minimally invasive alternative to open thoracotomy 4, 5
Considerations for Decortication
When considering decortication for trapped lung, the following factors should be taken into account:
- Stage of empyema, as VATS decortication may be more effective in early stages (stage II or early stage III) 3, 2
- Patient's overall health and potential for postoperative complications, such as respiratory failure and sepsis 6
- Potential need for lung resection, which may be required in some cases of empyema 2
Alternative Approaches
Alternative approaches to VATS decortication may include: