Intrapleural fibrinolytics combined with image-guided chest tube drainage for pleural infection.
OBJECTIVE
To present our method of treating pleural infection by using a combination of image-guided chest tube drainage and intrapleural fibrinolytics.


METHODS
We retrospectively reviewed the medical charts and radiographs of 30 consecutive patients with pleural infection who were seen at our institution from December 15, 1995, to July 1, 2006, 27 of whom received intrapleural urokinase or tissue-type plasminogen activator. End points were death, length of stay in the hospital, and percentage of patients who needed surgery.


RESULTS
Placement of chest tubes required image guidance 45.7% of the time. Three patients (10%; 95% confidence interval, 2.1%-26.5%) died of complications from pleural infection. None of the 30 patients (0%; 95% confidence interval, 0%-9.5%) required surgery for treatment of pleural infection. The median hospital length of stay was 11 days.


CONCLUSIONS
In the treatment of pleural infection, intrapleural urokinase or tissue-type plasminogen activator in combination with careful image-guided placement of chest tubes is highly effective in resolving the effusion and curing the infection.
Levinson
Gary M
GM
Mercy Medical Center of North Iowa, 1000 4th St SW, Mason City, IA 50401, USA. levinsog@mercyhealth.com
Pennington
Daniel W
DW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D015505:Chest Tubes; D004322:Drainage / Q000379:methods*; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D010994:Pleura; D010995:Pleural Diseases / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator