[Endocavitary drainage (Monaldi's technic) in the treatment of pulmonary abscess].

Abstract

The technique of intracavitary aspiration introduced by Monaldi in 1938 in the treatment of tuberculous cavities and then applied by him in the treatment of lung abscesses was forgotten for nearly 30 years. The advent of antibiotics and their success explain its abandonment. It may take an important place again in the treatment of difficult cases, as a last resort, after failure of properly conducted classical medical treatment. A study of 20 hospitalised patients in an intensive care unit presenting with severe pulmonary abscesses demonstrates this point. After recalling the causes, the therapeutic difficulties and the complications of these abscesses, the authors describe the medications, the method of endocavitary drainage and the technical problems posed by its use in patients often artificially ventilated. The absence of any major dangers inherent in using this technique is also discussed. Finally the short (one month) and long term (20 months) results were analysed. Three deaths occurred during the initial period, although largely explained by associated lesions in these patients. The other 17 patients, of whom 11 were followed up for more than six months, had a satisfactory outcome from the respiratory stand-point. The disappearance of all signs of infection was constantly obtained and in only four patients the bullous cavities persisted. The authors conclude by attesting the efficacy of the technique and its low risk often in the most critically ill patients.