BackgroundWe report our initial experience with intrathoracic negative pressure therapy (ITNPT) in the stage-adjusted treatment of pleural empyema (PE) based on a case series.Materials and methodsITNPT represents a further development for intrathoracic use. After thoracic surgical open debridement, an intrathoracic negative pressure dressing was inserted. The drainage elements were a thin open-pore double-layer drainage film (OF) with open-pore polyurethane foams (PUF). Only the OF was placed in direct contact with the lung parenchyma. Negative pressure was generated using an electronic pump (continuous suction, −75 mm Hg). In revision thoracotomies, ITNPT was stopped or continued depending on local findings.ResultsIn total, 31 patients with stage II and III pleural empyema underwent ITNPT, which was administered during the primary procedure (n= 17) or at revision (n= 14). Treatment duration was a mean of 10 days (2–18 days) with a mean change interval of 4 days (2–6 days). Intrathoracic negative pressure dressings were applied a mean of 3.5 (1–6) times. The empyema cavity continuously reduced in size and was cleansed by the suction. The OF has a minimum intrinsic volume with maximum absorption surface. Once negative pressure is established, there is no intrathoracic dead volume and the parenchyma can expand. The protective material properties of OF make ITNPT suitable for the treatment of pleural empyema. Targeted local intrathoracic drainage of the septic focus is a possible adjunct to surgery. The surgical dressings must be changed repeatedly. The method is suitable for the treatment of complex stage II and III pleural empyemas.ConclusionThe OF can be used as an intrathoracic drainage element for ITNPT in pleural empyema. This new application option expands the range of indications for negative pressure therapy.