Medical and Surgical Treatment of Parapneumonic Effusions

Colice, Gene; Curtis, Anne McB.; Deslauriers, Jean; Heffner, John E.; Light, Richard W.; Littenberg, Benjamin; Sahn, Steven A.; Weinstein, Robert A.; Yusen, Roger D.

doi:10.1378/chest.118.4.1158

Cited by 604 publications

(477 citation statements)

References 40 publications

Supporting

Mentioning

427

Contrasting

Unclassified

Order By: Relevance

“…Consequently, we only used data provided by chest radiographs and found a rate of pleural effusion of 19%, and a rate of E/CPE of 6%. These results are concordant with most recent, large epidemiological studies that report incidences of pleural effusion of 10-21% [13][14][15], and disagree with incidences of 40-60% referred to in some review papers [2,8,16].…”

Section: Discussionsupporting

confidence: 87%

“…Thoracocentesis is now mandatory for patients with CAP and pleural effusion [2,11]. A prediction model able to recognise patients with high risk for E/CPE could be useful to physicians in making decisions for treatment management of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, while those with UPE are treated with antibiotics alone, patients with E/CPE require pleural drainage with or without fibrinolytics or thoracic surgery [2,3]. In addition, the latter also have a worse prognosis, particularly when the adequate management is delayed [4].…”

mentioning

confidence: 99%

See 2 more Smart Citations

Predictive factors, microbiology and outcome of patients with parapneumonic effusion

Falguera

Carratalà²,

Bielsa³

et al. 2011

Eur Respir J

111

View full text Add to dashboard Cite

We aimed to determine the incidence, clinical consequences and microbiological findings related to the presence of pleural effusion in community-acquired pneumonia, and to identify predictive factors for empyema/complicated parapneumonic effusion.We analysed 4,715 consecutive patients with community-acquired pneumonia from two acute care hospitals. Patients were classified into three groups: no pleural effusion, uncomplicated parapneumonic effusion and empyema/complicated parapneumonic effusion.A total of 882 (19%) patients had radiological evidence of pleural fluid, of whom 261 (30%) met criteria for empyema/complicated parapneumonic effusion. The most important event related to the presence of uncomplicated parapneumonic effusion was a longer hospital stay. Relevant clinical and microbiological consequences were associated with empyema/complicated parapneumonic effusion. Five independent baseline characteristics could predict the development of empyema/ complicated parapneumonic effusion: age ,60 yrs (p50.012), alcoholism (p50.002), pleuritic pain (p50.002), tachycardia .100 beats?min -1 (p50.006) and leukocytosis .15,000 mm -3 (p,0.001). A higher incidence of anaerobes and Gram-positive cocci was found in this subgroup of patients. We conclude that only the development of empyema/complicated parapneumonic effusion carried relevant consequences; this condition should be suspected in the presence of some baseline characteristics and managed by using antimicrobials active against Gram-positive cocci and anaerobes.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Predictive factors, microbiology and outcome of patients with parapneumonic effusion

Falguera

Carratalà²,

Bielsa³

et al. 2011

Eur Respir J

111

View full text Add to dashboard Cite

show abstract

“…Clinical failure was defined as: death within 30 days of admission; readmission within 30 days of discharge; tube thoracostomy, thoracotomy or decortication required during hospitalisation or within 30 days; or pleural fluid results consistent with complicated PPE or empyema as defined by the American College of Chest Physician guidelines [14,15]. Data on patients with clinical failure were reviewed and discussed amongst a panel of six infectious and pulmonary disease physicians to classify the outcome as PPE related, PPE unrelated or not evaluable.…”

Section: Study Outcomesmentioning

confidence: 99%

Computed tomography measurements of parapneumonic effusion indicative of thoracentesis

Moffett

Panchabhai²,

Anaya³

et al. 2011

Eur Respir J

View full text Add to dashboard Cite

Patients with parapneumonic effusions (PPE) measuring ,1 cm by lateral decubitus radiograph (LDR) or ,5 cm by lateral erect radiograph (LER) do not require thoracentesis. No such data exist for chest computed tomography (CCT). The objective of this study was to identify a PPE measurement by CCT that indicates the need for thoracentesis.A secondary data analysis of two pneumonia databases was conducted to identify patients with PPE. Measurements of PPE using LDR, LER and CCT were correlated by linear regression analysis. The clinical outcome of community-acquired pneumonia patients managed with the newly defined CCT measurement was evaluated.PPE was identified in 419 out of 1,460 patients with possible pneumonia. PPE measurements of 1 cm and 5 cm by LDR and LER, respectively, correlated with a measurement of 2.5 cm by CCT. Out of 95 patients with CCT measurements ,2.5 cm, 31 poor clinical outcomes were reported: outcome was PPE related (n51); outcome was PPE unrelated (n526); and outcome was not evaluable (n54). The single case of poor outcome also measured ,1 cm by LDR.This study indicates that patients with community-acquired pneumonia and a PPE measuring ,2.5 cm by CCT can be managed without the need for thoracentesis.

show abstract

“…These findings were consistent with a "category 3" process with a moderate risk for poor outcome according to the American College of Chest Physicians consensus statement. 1 The patient required minimal supplemental oxygen, and she was continued on intravenous cefuroxime at a dosage of 150 mg/kg/d in 3 divided doses. On hospital day 2, the plasma WBC count increased to 27 800/mm 3 with 61% neutrophils and 18% bands.…”

Section: Case Reportmentioning

confidence: 99%