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Management of complicated parapneumonic effusions and thoracic empyema
Author(s) -
Cameron R. J.
Publication year - 2002
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1046/j.1445-5994.2002.00252.x
Subject(s) - medicine , empyema , parapneumonic effusion , debridement (dental) , surgery , intensive care medicine , chest tube , fibrinolytic therapy , psychological intervention , pleural fluid , pleural effusion , fibrinolysis , pneumothorax , psychiatry
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. (Intern Med J 2002; 32: 408−414)