Table 37-10
- Drain empyema before induction of anesthesia.
- Awake tracheal intubation with a double-lumen tube (bronchial lumen directed to the side opposite the fistula; anticipate outpouring of pus from the tracheal lumen if an empyema is present).
- Instituting controlled ventilation before placement of a double-lumen tube may result in hypoventilation because of a large air leak.
- Leave the chest drainage tube open to prevent tension pneumothorax.