{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T06:28:45Z","timestamp":1792650525714,"version":"4.5.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:00:00Z","timestamp":1618876800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:00:00Z","timestamp":1618876800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Complicated parapneumonic effusions and empyema represent advanced stages of pleural infections and are characterized by a high mortality. Medical thoracoscopy is a safe and minimally invasive endoscopic technique prescribed to treat severe pleural infections. However, only a few studies evaluated its success rate. A systematic review of observational studies was performed to assess the efficacy of medical thoracoscopy in patients with complicated parapneumonic effusions and empyema, as well as its predictive factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A search of the scientific evidence was carried out using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. Articles describing observational studies on medical thoracoscopy in patients with parapneumonic effusions and empyema were selected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eight studies met the inclusion criteria. The pooled treatment success rate of thoracoscopy was 85% (95% CI 80.0\u201390.0%; I\n                      <jats:sup>2<\/jats:sup>\n                      : 61.8%) when used as first-line intervention or after failure of chest tube. The pooled complication rate was 9.0% (95% CI 6.0\u201314.0%; I\n                      <jats:sup>2<\/jats:sup>\n                      : 58.8%). A pooled difference of treatment success of 9.0% (95% CI 1.0\u201318.0%) was found when post-thoracoscopy intra-pleural fibrinolysis was prescribed. Pooled success rate was higher in cases with pleural fluid culture negativity (pooled difference: 14.0%; 95% CI 4.0\u201324.0%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Medical thoracoscopy is effective and safe when prescribed for complicated parapneumonic effusions and empyema. Bacteriological negativity of pleural effusion specimens and administration of adjuvant intra-pleural fibrinolysis after the procedure are associated with a higher success rate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12890-021-01492-9","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T07:09:37Z","timestamp":1618902577000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Medical thoracoscopy treatment for pleural infections: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"21","author":[{"given":"Michele","family":"Mondoni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Saderi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Trogu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Terraneo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Carlucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Ghelma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Centanni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Sotgiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,20]]},"reference":[{"issue":"7","key":"1492_CR1","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/S2213-2600(15)00185-X","volume":"3","author":"JP Corcoran","year":"2015","unstructured":"Corcoran JP, Wrightson JM, Belcher E, DeCamp MM, Feller-Kopman D, Rahman NM. Pleural infection: past, present, and future directions. Lancet Respir Med. 2015;3(7):563\u201377.","journal-title":"Lancet Respir Med"},{"issue":"5","key":"1492_CR2","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1183\/09031936.00000211","volume":"38","author":"M Falguera","year":"2011","unstructured":"Falguera M, Carratal\u00e0 J, Bielsa S, Garc\u00eda-Vidal C, Ruiz-Gonz\u00e1lez A, Chica I, et al. Predictive factors, microbiology and outcome of patients with parapneumonic effusion. Eur Respir J. 2011;38(5):1173\u20139.","journal-title":"Eur Respir J"},{"issue":"7","key":"1492_CR3","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1136\/thx.2008.105080","volume":"64","author":"JD Chalmers","year":"2009","unstructured":"Chalmers JD, Singanayagam A, Murray MP, Scally C, Fawzi A, Hill AT. Risk factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia. Thorax. 2009;64(7):592\u20137.","journal-title":"Thorax"},{"issue":"Suppl 2","key":"1492_CR4","doi-asserted-by":"publisher","first-page":"ii41","DOI":"10.1136\/thx.2010.137000","volume":"65","author":"HE Davies","year":"2010","unstructured":"Davies HE, Davies RJ, Davies CW, British Thoracic Society Pleural Disease Guideline Group. Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(Suppl 2):ii41\u201353.","journal-title":"Thorax"},{"issue":"4","key":"1492_CR5","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/0002-9343(80)90460-X","volume":"69","author":"RW Light","year":"1980","unstructured":"Light RW, Girard WM, Jenkinson SG, George RB. Parapneumonic effusions. Am J Med. 1980;69(4):507\u201312.","journal-title":"Am J Med"},{"issue":"6","key":"1492_CR6","doi-asserted-by":"publisher","first-page":"e129","DOI":"10.1016\/j.jtcvs.2017.01.030","volume":"153","author":"KR Shen","year":"2017","unstructured":"Shen KR, Bribriesco A, Crabtree T, Denlinger C, Eby J, Eiken P, et al. The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg. 2017;153(6):e129\u201346.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"Suppl 2","key":"1492_CR7","doi-asserted-by":"publisher","first-page":"ii54","DOI":"10.1136\/thx.2010.137018","volume":"65","author":"NM Rahman","year":"2010","unstructured":"Rahman NM, Ali NJ, Brown G, Chapman SJ, Davies RJ, Downer NJ, et al. Local anaesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(Suppl 2):ii54\u201360.","journal-title":"Thorax"},{"issue":"3","key":"1492_CR8","doi-asserted-by":"publisher","first-page":"326","DOI":"10.23736\/S0031-0808.18.03564-4","volume":"61","author":"P Carlucci","year":"2019","unstructured":"Carlucci P, Trigiani M, Mori PA, Mondoni M, Pinelli V, Casalini AG, et al. Competence in pleural procedures. Panminerva Med. 2019;61(3):326\u201343.","journal-title":"Panminerva Med"},{"issue":"8","key":"1492_CR9","doi-asserted-by":"publisher","first-page":"2309","DOI":"10.1111\/crj.12941","volume":"12","author":"EO Bedawi","year":"2018","unstructured":"Bedawi EO, Hassan M, Rahman NM. Recent developments in the management of pleural infection: a comprehensive review. Clin Respir J. 2018;12(8):2309\u201320.","journal-title":"Clin Respir J"},{"issue":"42","key":"1492_CR10","first-page":"1748","volume":"127","author":"M Sol\u00e8r","year":"1997","unstructured":"Sol\u00e8r M, Wyser C, Bolliger CT, Perruchoud AP. Treatment of early parapneumonic empyema by \u201cmedical\u201d thoracoscopy. Schweiz Med Wochenschr. 1997;127(42):1748\u201353.","journal-title":"Schweiz Med Wochenschr"},{"issue":"5","key":"1492_CR11","doi-asserted-by":"publisher","first-page":"3303","DOI":"10.1378\/chest.128.5.3303","volume":"128","author":"MH Brutsche","year":"2005","unstructured":"Brutsche MH, Tassi GF, Gy\u00f6rik S, G\u00f6kcimen M, Renard C, Marchetti GP, Tschopp JM. Treatment of sonographically stratified multiloculated thoracic empyema by medical thoracoscopy. Chest. 2005;128(5):3303\u20139.","journal-title":"Chest"},{"issue":"3","key":"1492_CR12","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1159\/000339414","volume":"84","author":"C Ravaglia","year":"2012","unstructured":"Ravaglia C, Gurioli C, Tomassetti S, Casoni GL, Romagnoli M, Gurioli C, et al. Is medical thoracoscopy efficient in the management of multiloculated and organized thoracic empyema? Respiration. 2012;84(3):219\u201324.","journal-title":"Respiration"},{"issue":"8","key":"1492_CR13","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1007\/s11748-014-0405-y","volume":"62","author":"M Ohuchi","year":"2014","unstructured":"Ohuchi M, Inoue S, Ozaki Y, Fujita T, Igarashi T, Ueda K, Hanaoka J. Single-trocar thoracoscopy under local anesthesia for pleural space infection. Gen Thorac Cardiovasc Surg. 2014;62(8):503\u201310.","journal-title":"Gen Thorac Cardiovasc Surg"},{"issue":"1","key":"1492_CR14","first-page":"52","volume":"8","author":"Y Xiong","year":"2016","unstructured":"Xiong Y, Gao X, Zhu H, Ding C, Wang J. Role of medical thoracoscopy in the treatment of tuberculous pleural effusion. J Thorac Dis. 2016;8(1):52\u201360.","journal-title":"J Thorac Dis"},{"issue":"3","key":"1492_CR15","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1016\/j.ejcdt.2016.12.013","volume":"66","author":"AHA Abo-El-maged","year":"2017","unstructured":"Abo-El-maged AHA, Elsamadony MF, El-Shamly MM, Hablas WR. Safety and efficacy of medical thoracoscopy in the management of loculated thoracic empyema. Egypt J Chest Dis Tuberc. 2017;66(3):445\u201351.","journal-title":"Egypt J Chest Dis Tuberc"},{"issue":"1","key":"1492_CR16","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1097\/LBR.0000000000000310","volume":"24","author":"G Hardavella","year":"2017","unstructured":"Hardavella G, Papakonstantinou NA, Karampinis I, Papavasileiou G, Ajab S, Shafaat M, et al. Hippocrates quoted \u201cIf an Empyema Does Not Rupture, Death Will Occur\u201d: is medical thoracoscopy able to make it rupture safely? J Bronchology Interv Pulmonol. 2017;24(1):15\u201320.","journal-title":"J Bronchology Interv Pulmonol"},{"issue":"1","key":"1492_CR17","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1186\/s12890-018-0745-y","volume":"18","author":"KK Sumalani","year":"2018","unstructured":"Sumalani KK, Rizvi NA, Asghar A. Role of medical thoracoscopy in the management of multiloculated empyema. BMC Pulm Med. 2018;18(1):179.","journal-title":"BMC Pulm Med"},{"issue":"5","key":"1492_CR18","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1093\/ejcts\/ezu104","volume":"46","author":"L Okikor","year":"2014","unstructured":"Okikor L, Coltart C, Bille A, Guile L, Pilling J, Harrison-Phipps K, et al. Thoracotomy and decortication: impact of culture-positive empyema on the outcome of surgery. Eur J Cardiothorac Surg. 2014;46(5):901\u20136.","journal-title":"Eur J Cardiothorac Surg"},{"issue":"3","key":"1492_CR19","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1016\/j.chest.2018.01.037","volume":"154","author":"D Khemasuwan","year":"2018","unstructured":"Khemasuwan D, Sorensen J, Griffin DC. Predictive variables for failure in administration of intrapleural tissue plasminogen activator\/deoxyribonuclease in patients with complicated parapneumonic effusions\/empyema. Chest. 2018;154(3):550\u20136.","journal-title":"Chest"},{"issue":"3","key":"1492_CR20","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1055\/s-0039-1694699","volume":"40","author":"MS Godfrey","year":"2019","unstructured":"Godfrey MS, Bramley KT, Detterbeck F. Medical and surgical management of empyema. Semin Respir Crit Care Med. 2019;40(3):361\u201374.","journal-title":"Semin Respir Crit Care Med"},{"issue":"6","key":"1492_CR21","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1056\/NEJMoa1012740","volume":"365","author":"NM Rahman","year":"2011","unstructured":"Rahman NM, Maskell NA, West A, Teoh R, Arnold A, Mackinlay C, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011;365(6):518\u201326.","journal-title":"N Engl J Med"},{"key":"1492_CR22","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002312.pub4","author":"ES Altmann","year":"2019","unstructured":"Altmann ES, Crossingham I, Wilson S, Davies HR. Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev. 2019. https:\/\/doi.org\/10.1002\/14651858.CD002312.pub4.","journal-title":"Cochrane Database Syst Rev."},{"issue":"8","key":"1492_CR23","doi-asserted-by":"publisher","first-page":"958","DOI":"10.1513\/AnnalsATS.202001-076OC","volume":"17","author":"F Kheir","year":"2020","unstructured":"Kheir F, Thakore S, Mehta H, Jantz M, Parikh M, Chee A, et al. Intrapleural Fibrinolytic therapy versus early medical thoracoscopy for treatment of pleural infection: randomized clinical trial. Ann Am Thorac Soc. 2020;17(8):958\u201364.","journal-title":"Ann Am Thorac Soc"},{"key":"1492_CR24","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.ejim.2018.09.015","volume":"59","author":"M Mondoni","year":"2019","unstructured":"Mondoni M, Radovanovic D, Sotgiu G, Di Marco F, Carlucci P, Centanni S, Santus P. Interventional pulmonology techniques in elderly patients with comorbidities. Eur J Intern Med. 2019;59:14\u201322.","journal-title":"Eur J Intern Med"}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-021-01492-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-021-01492-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-021-01492-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T07:25:54Z","timestamp":1618903554000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpulmmed.biomedcentral.com\/articles\/10.1186\/s12890-021-01492-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,20]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1492"],"URL":"https:\/\/doi.org\/10.1186\/s12890-021-01492-9","relation":{},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,20]]},"assertion":[{"value":"4 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Dr. Michele Mondoni and Prof. Giovanni Sotgiu are senior editorial board members of BMC Pulmonary Medicine.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"127"}}