Management of complicated parapneumonic effusions and thoracic empyema

Abstract

The optimal management of loculated parapneumonic effusions and empyema includes breakdown of adhesions to effect drainage of infected pleural fluid. The use of fibrinolytics intrapleurally appears to enhance intercostal tube drainage, reducing the requirement for subsequent surgical mechanical debridement. This article discusses the evidence for intrapleural fibrinolytics, their good safety profile and the practicalities of dose and administration. It also reviews early surgical intervention, which may be indicated for medical treatment failure and, some would argue, as a suitable alternative to other medical interventions.

Comparison of procalcitonin and CrP in the postoperative course after lung decortication

“…About 40-65% of the patients are not cured of their empyema by conservative therapy, i.e. chest tube drainage, antibiotics, urokinase, and therefore require surgical intervention (decortication) [7,8]. In the postoperative course clinical and laboratory parameters are needed to reflect the response to therapy in the follow-up.…”

Clinical presentation and management of empyema, lung abscess and pleural effusion

“…Side effects from impurities dampened enthusiasm, but more purified streptokinase and the availability of urokinase led to reappraisal of this fibrinolytic therapy [17,18].…”

The role of thoracoscopy in the treatment of pleural empyema in children

“…The possibility of administering a fibrinolytic agent to the pleural cavity, which causes fibrinolysis of accumulated fibrin, is remarkable [2,3,7,26]. To supplement mechanical decortication of the thick fibrin accumulation with chemical decortication, Distreptase was administered to the pleural cavity for 32.7% of the patients, mainly to those with stage III disease, and only sporadically to those with stage II disease.…”