Keywords
purulent diseases of the pleura
laboratory diagnostic
How to Cite
Abstract
In press
Background. Acute pleural empyema is a severe disease accompanied by high systemic intoxication, metabolic disturbances, and purulent septic complications. Conventional therapy – antibiotics, pleural drainage, and infusions – may be insufficient due to accumulation of toxins and disruption of homeostasis. While extracorporeal methods such as plasmapheresis appear promising, classic approaches are limited by substantial losses of plasma proteins and immune components. Photomodification of erythrocytes may enhance detoxification and stimulate tissue repair processes.
Aim. To assess the clinical efficacy, safety, and impact on tissue repair of three variants of detoxifying hemocorrection: Therapeutic Plasma Exchange (TPE), TPE with Partial Photomodification of Erythrocytes (TPE-PPE), and Small Volume TPE with Full Photomodification of Erythrocytes (SV-TPE-FPE) in patients with acute pleural empyema.
Materials and Methods. A total of 105 patients with acute nonspecific pleural empyema treated at the Institute of General and Emergency Surgery (2008–2024) were enrolled. Patients were stratified into four groups: control (standard therapy), TPE, TPE-PPE, and SV-TPE-FPE. Apheresis procedures were performed every other day. Efficacy was monitored via clinical parameters (body temperature, duration of fever, severity of condition), complications, and morphological changes. Statistical analysis was carried out using variation statistics and Student's t-test, with Bonferroni correction for multiple comparisons. The study was carried out as a private initiative of the authors, without grant support or state registration of the topic.
Research Ethics. The study was conducted in accordance with the principles of the World Medical Association Declaration of Helsinki (1964–2024) and approved by the Ethics Committee of the Educational and Scientific Medical Institute of National Technical University "Kharkiv Polytechnic Institute" (Protocol No.2 dated October 13, 2023). Written informed consent for the use of clinical data in scientific research was obtained from all patients, with adherence to the principles of confidentiality and voluntary participation.
Results. The SV-TPE-FPE group demonstrated the best clinical dynamics: maximal body temperature decreased to 37.1°C, and the fever period was shortest (mean ≈ 18 days). The complication rate in this group was significantly lower than in other groups: fewer purulent septic complications and a reduced need for surgical interventions. No deaths were recorded in the SV-TPE-FPE group. Morphologically, there was the largest proportion of spontaneous scarring of pleural cavities in this group, suggesting activation of reparative processes.
Conclusions. Small volume TPE with full photomodification of erythrocytes (SV-TPE-FPE) appears to be a promising method for treating acute pleural empyema, combining effective detoxification with activation of repair and reduced complication rates with no fatal outcomes in the studied sample. These findings support incorporating photomodified erythrocytes into comprehensive therapy, but further multicenter randomized studies are required to validate these results.
Keywords: surgery, purulent diseases of the pleura, laboratory diagnostic.
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