Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study

Misthos, Panagiotis; Sepsas, Evangelos; Konstantinou, Marios; Athanassiadi, Kalliopi; Skottis, Ion; Lioulias, Achilleas

doi:10.1016/j.ejcts.2005.07.005

Cited by 110 publications

(80 citation statements)

References 16 publications

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“…Hence, the fibrinolytic agent can be applied for improvement of drainage. A series studies also considered that the streptokinase or urokinase used in the pleural cavity can reduce hospital stay, prognosis improvement (9,(47)(48)(49)(50)(51) and prevent catastrophic hazards (4,50,52,53). However, the largest random and controlled clinical study considers that streptokinase application in the pleural cavity has failed to improve hospital stay, death rate and others, to date (22) and a researcher also considers that the fibrinolytic agent has failed to reduce fatality rate (54).…”

Section: Intrapleural Cavity Injectionmentioning

confidence: 99%

Infectious pleural effusion status and treatment progress

Yang

Zhang

2017

J. Thorac. Dis.

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Pleural cavity infection continuously seriously threatens human health with continuous medical progress. From the perspective of pathophysiology, it can be divided into three stages: exudative stage, fibrin exudation and pus formation stage, and organization stage. Due to the pathogenic bacteria difference of pleural cavity infection and pulmonary infection, it is very important for disease treatment to analyze the bacteria and biochemical characteristics of the infectious pleural effusion. Most prognoses of patients have been relatively good, while for some patients, the complicated parapneumonic effusion or empyema could be evolved. Antibiotic treatment and sufficient drainage are the foundation for this treatment. No evidence can support the routine use of a fibrin agent. However, it has been reported that the plasminogen activator and deoxyribonuclease can be recommended to be applied in the pleural cavity. In case of failure on conservative medical treatment, operative treatment can be applied such as thoracoscopy and pleural decortication.According to the clinical characteristics of these patients, it is a key to research prognosis, as well as early evaluation and stratification, in the future.

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Section: Intrapleural Cavity Injectionmentioning

confidence: 99%

Infectious pleural effusion status and treatment progress

Yang

Zhang

2017

J. Thorac. Dis.

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“…The families usually end-up spending all their meager resources on consultations and prolonged courses of expensive broad spectrum antibiotics far more than the cost of adequate treatment in a hospital. Misthos et al [8] in their study reported fever as the most common presenting symptom (88%) followed by cough (73%). We also observed fever as the frequent symptom (85.77%) followed by cough (61, 78).…”

Section: Discussionmentioning

confidence: 99%

Management for Pediatric Pleural Empyema in Resource-Poor Country: Is Chest Tube Drainage with Antiseptic Lavage-Irrigation Better than Tube Thoracostomy Alone?

Togo¹,

Ouattara²,

Sangaré³

et al. 2015

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Background: Drainage by chest tube thoracostomy is widely used in treatment of early empyema thoracis in children, but drainage with antiseptic lavage-irrigation is more frequent in our context since the last 20 years. This study was to determine which was more effective in our experience comparing chest tube drainage with catheter antiseptic lavage-irrigation versus drainage by chest tube thoracostomy alone in the management of empyema thoracis in children. S. Togo et al. 542situ, less cost and better outcome of stage 2 empyema diseases than a treatment strategy that utilizes chest tube thoracostomy alone.

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“…Em um estudo controlado amplo, os trombolíticos não mostraram eficácia no controle do DPP loculado e do empiema, quando comparados com tratamentos convencionais. (24) Estudos atuais têm sugerido a utilização de agente trombolítico na primeira semana após o diagnóstico das septações, (25) com resultados animadores principalmente em pediatria. (26) Devemos também considerar que pacientes de alto risco operatório para o uso de anestesia geral podem se beneficiar da utilização alternativa dos trombolíticos.…”

Section: Agentes Trombolíticosunclassified

“…Um aumento importante do volume de líquido drenado após a instilação do trombolítico é um dos sinais mais importantes que sugerem ação na lise das loculações. (25)(26) Febre, calafrios e reações alérgicas podem ser relatados com a utilização da estreptoquinase, porém complicações mais sérias como sangramento pleural, fibrilação ventricular e insuficiência respiratória aguda são raras. (27) Os trombolíticos administrados no espaço pleural não alteram a coagulação sistêmica, sendo considerados drogas seguras para a prática clínica.…”

Section: Agentes Trombolíticosunclassified

Derrame pleural parapneumônico e empiema

2006

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O derrame pleural parapneumônico (DPP) ocorre durante o curso clínico de uma pneumonia ou abscesso pulmonar. Sua incidência é freqüentemente subestimada, podendo aparecer em cerca de 25% a 44% dos casos de pneumonias adquiridas na comunidade (PAC).(1-3) Na maioria das vezes o quadro clínico do DPP se sobrepõe ao da PAC, sendo ele descoberto devido à realização da radiografia de tórax para o diagnóstico inicial ou avaliação da falta de resposta ao tratamento para a PAC.A maioria desses derrames é resolvida com o mesmo tratamento antibiótico da PAC, e sua presença pode passar despercebida. ABSTRACTThe infectious effusion, one of the most frequent causes of pleural effusions in the clinical practice, is a sign of complication of the pneumonic disease. The early recognition of the parapneumonic effusion is crucial to determine the best treatment form and reduce the risk of morbidity and mortality. The evolution in the diagnostic methods and the contribution of several studies published in the literature allowed to establish evidence-based guidelines that are used to guide the treatment of the parapneumonic pleural effusion and empyema.Keywords: Pneumonia/complications; Pleural effusion/etiology; Drainage; Empyema, pleural; Radiography, thoracic RESUMOO derrame infeccioso, uma das causas mais freqüentes de derrame pleural obervados na pratica clinica, é um sinal de complicação do quadro pneumônico. O reconhecimento precoce do derrame parapneumônico é fundamental para determinar a melhor forma de tratamento, reduzindo o risco de morbidade e mortalidade. A evolução dos métodos diagnósticos e a experiência dos diversos estudos publicados na literatura permitiram estabelecer diretrizes baseadas em evidencias que orientam a conduta de abordagem terapêutica do derrame parapneumônico e empiema.Descritores: Pneumonia/complicações; Derrame pleural/etiologia; Drenagem; Empiema pleural; Radiografia torácica tações (denominados de DPP complicados) ou para empiema pleural. (4)(5)(6) EPIDEMIOLOGIANo Brasil, existem estudos localizados em que a incidência de DPP se encontra entre 20% e 30% dos casos de PAC internados.(3-7) Em 2005, calculase que o número de pacientes com PAC internados foi de aproximadamente 730.000, (8) o que permite estimar entre 140.000 e 210.000 casos de DPP.Na literatura mundial, estima-se que 10% dos DPP podem evoluir para DPP complicado ou empiema pleural, (2) com a mortalidade situando-se entre 6% e 10% dos casos. (4,6) No Brasil, não dis- Capítulo 5Capítulo 5

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Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study

Cited by 110 publications

References 16 publications

Infectious pleural effusion status and treatment progress

Infectious pleural effusion status and treatment progress

Management for Pediatric Pleural Empyema in Resource-Poor Country: Is Chest Tube Drainage with Antiseptic Lavage-Irrigation Better than Tube Thoracostomy Alone?

Derrame pleural parapneumônico e empiema

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