Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study.
OBJECTIVE
A prospective randomized study was conducted in order to analyze the role of fibrinolytics in the treatment of complicated parapneumonic effusion.


METHODS
From 2001 to 2004, 127 consecutive patients were managed for thoracic empyema. In all cases the cause was bacterial pneumonia. Seventy patients were managed with sole tube thoracostomy (group A) and 57 with combination of tube thoracostomy and streptokinase instillation (group B). Groups were statistically compared for the age, gender, duration of symptoms, quality of pleural fluid, chest imaging, complete drainage, length of hospital stay and mortality. Multivariate analysis was used in order to define the factors that affect outcome.


RESULTS
Tube thoracostomy was successful in 47 (67.1%) cases (group A), while fibrinolysis led to a favorable outcome in 50 cases (87.7%) (P<0.05). The length of stay in thoracic surgical department was significantly longer for group A (P<0.001). Mortality rate in group A was significantly higher (P<0.001). Multiple regression analysis disclosed as sole independent favorable factor for pleural drainage, the use of fibrinolysis during the course of chest tube drainage (P=0.006, odds ratio 4.29, 95% CI 1.51-12.14).


CONCLUSIONS
Fibrinolytic agents are a useful adjunct in the management of complicated parapneumonic effusions. Intrapleural fibrinolytics, if used early in the fibrinopurulent stage of a parapneumonic effusion, decrease the rate of surgical interventions (VATS or open decortcation) and the length of hospital stay with minor associated morbidity.
Misthos
Panagiotis
P
Thoracic Surgical Department, General Hospital for Chest Diseases SOTIRIA, 7 Dimitrakopoulou Street, 11141 Athens, Greece. panmisthos@yahoo.gr
Sepsas
Evangelos
E
Konstantinou
Marios
M
Athanassiadi
Kalliopi
K
Skottis
Ioannis
I
Lioulias
Achilles
A
D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods; D016724:Empyema, Pleural / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007322:Instillation, Drug; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D011014:Pneumonia / Q000150:complications / Q000382:microbiology; D011446:Prospective Studies; D013300:Streptokinase / Q000008:administration & dosage*; D013907:Thoracostomy / Q000379:methods; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D013300:Streptokinase