Intrapleural fibrinolytic treatment of multiloculated thoracic empyemas

Robinson, Lary A.; Moulton, Anthony L.; Fleming, William H.; Alonso, Anselmo; Galbraith, Timothy A.

doi:10.1016/0003-4975(94)90180-5

Cited by 140 publications

(80 citation statements)

References 23 publications

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“…Where as streptokinase has been reported to be effective and safe in patients with CPE and PE, urokinase has rarely been evaluated [14][15][16][17][18]. Urokinase is a direct plasminogen activator, which is not antigenic, and the rare reactions observed with it are probably related to contaminants (pyrogens) in the solution [18].…”

Section: Discussionmentioning

confidence: 99%

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Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema

Bouros

Schiza²,

Tzanakis³

et al. 1996

Eur Respir J

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Intrapleural urokinase has not been evaluated systemically in terms of efficacy, safety, and cost of treatment in a large series of patients with complicated (parapneumonic) pleural effusions (CPE) and pleural empyemas (PE). Furthermore, the optimal dose and duration of treatment is not known.Twenty consecutive patients with multiloculated parapneumonic effusions (13 with CPE and 7 with PE), in whom a single chest tube failed to drain the fluid, were studied prospectively. The age of the patients ranged 15-92 yrs (median 51 yrs). Urokinase was administered intrapleurally, in a low single daily dose of 50,000 U in 100 mL normal saline via the chest tube. Previous intrapleural instillation of 100 mL normal saline failed to promote drainage in all patients.Urokinase enhanced drainage in all patients. Clinical and radiological improvement was noted in all but one patient. The mean (SD) volume of fluid significantly increased in the first 24 h post-urokinase (p<0.001). The number of urokinase instillations ranged 3-7 (median 5). Radiological evaluation showed excellent improvement in 13 of the 20 (65%) patients. Urokinase was well-tolerated in all patients. The clinical course of patients was uneventful at a mean follow-up of 15 months (range 6-30 months) later. Mean total cost of treatment was $530±34.6.Our results show that intrapleural instillation of small doses of urokinase is a cost-effective and safe mode of treatment of complicated pleural effusions and pleural empyema and could be the fibrinolytic of choice.

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Section: Discussionmentioning

confidence: 99%

“…In a few small series, intrapleural administration of urokinase has been shown to be effective in PPE and PE [14][15][16][17][18]. However, its role in terms of efficacy and safety has not been studied systematically and the optimal dose and duration of treatment is not known.…”

mentioning

confidence: 99%

Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema

Bouros

Schiza²,

Tzanakis³

et al. 1996

Eur Respir J

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“…In addition, localized abscess cavities should be drained, and chest drainage is commonly indicated. There is no documented role for topical anti®brinolytic treatment, which we attempted, or for systemic anticoagulation 10,11 .…”

Section: Case Historymentioning

confidence: 99%

Facial Pain With Intracranial Aneurysm

2001

Aust Endodontic J

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“…However, if CT scan does not show thick peel, thoracoscopic debridement or fibrinolytic adhesolysis are advocated by many workers. 3,9,12 In summary, parapneumonic effusion should be treated aggressively by physicians. Early drainage and proper antibiotics are recommended to prevent progression to late stage of loculation or formation of thick fibrotic peel around the lung.…”

Section: -9mentioning

confidence: 99%

Bilateral Empyema Thoracis Treated by Staged Thoracotomies

et al. 1999

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Pleural effusion is a common finding following pneumonia. It can become infected with accumulation of pus, forming empyema thoracis (ET), which is frequently encountered in childhood. Proper drainage and broad-spectrum antibiotics are the mainstays of treatment. However, operative intervention is another mode of therapy in later stages of the condition. Election of either mode of therapy is a controversial issue, and depends largely on the discipline of the treating clinician. We report a case of bilateral ET treated by operative intervention, and review the current modes of therapy in the literature. Case ReportA 10-month-old Saudi girl born after a normal term pregnancy and uneventful delivery presented to the pediatric service with high-grade fever, productive cough, shortness of breath, lethargy and poor suckling of two weeks' duration.On examination, she was febrile, dehydrated, irritable and underweight. She had a flaring of the ala nasi and subcostal recession, but there was no lymphadenopathy. Examination of the chest revealed reduced air entry bilaterally, bilateral ronchi and a dull percussion note at the base of the right hemithorax. Initial laboratory investigations revealed white cell count of 16.3x10 9 /L, with 63% polymorphonuclear forms, hemoglobin of 10.2 g/dL, Westerngren erythrocyte sedimentation rate of 75 mm in the first hour, and blood glucose of 100 mg/dL (normal, 80-110 mg/dL). Other laboratory investigations were normal.Initial radiographic study of the chest revealed a bilateral homogenous alveolar infiltrate mainly at the lower lobes, with minimal pleural effusion at the right hemithorax (Figure 1). Thoracocentesis revealed a turbid, yellowish aspirate, analysis of which showed pH 7.12, protein 6 g/dL, glucose 30 mg/dL, lactate dehydrogenase 1416 U/L and white cell count 300/mm 3 . The initial working diagnosis was bilateral bronchopneumonia with a right-sided complicated parapneumonic effusion. Initial treatment included chest physiotherapy, antipyretics and broad-spectrum antibiotics (thirdgeneration cephalosporin, ceftriaxone, and gentamycin) covering both gram-positive and negative bacteria. An intercostal tube (ICT) was inserted through the right fifth intercostal space, mid-axillary line under local anesthesia. Around 100 mL of turbid fluid was drained. The pleural fluid culture grew no bacteria, while throat swab grew Klebsiella species sensitive to gentamycin.One week after initiation of the antibiotics, a follow-up chest radiograph revealed development of a left-sided pleural effusion. Another ICT was inserted at the left hemithorax. Minimal purulent fluid was drained, and bacterial culture revealed Staphylococcus aureus, sensitive to vancomycin, which was added to the antibiotics.Four weeks after admission, the patient was referred to the thoracic surgical service, where a CT scan revealed bilateral, loculated, pleural effusions with a thickened cortex around both lower lobes ( Figure 2).The decision was made to perform surgical decortication of both lungs for two reasons: 1)...

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Intrapleural fibrinolytic treatment of multiloculated thoracic empyemas

Cited by 140 publications

References 23 publications

Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema

Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema

Facial Pain With Intracranial Aneurysm

Bilateral Empyema Thoracis Treated by Staged Thoracotomies

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