title: Treatment of complicated parapneumonic pleural effusion and pleural parapneumonic empyema.
abstract: BACKGROUND
  We performed this observational prospective study to evaluate the results of the application of a diagnostic and therapeutic algorithm for complicated parapneumonic pleural effusion (CPPE) and pleural parapneumonic empyema (PPE).
  
  
  METHODS
  From 2001 to 2007, 210 patients with CPPE and PPE were confirmed through thoracocentesis and treated with pleural drainage tubes (PD), fibrinolytic treatment or surgical intervention (videothoracoscopy and posterolateral thoracotomy). Patients were divided into 3 groups: I (PD); II (PD and fibrinolytic treatment); IIIa (surgery after PD and fibrinolysis), and IIIb (direct surgery). The statistical study was done by variance analysis (ANOVA), χ2 and Fisher exact test.
  
  
  RESULTS
  The presence of alcohol or drug consumption, smoking and chronic obstructive pulmonary disease (COPD) were strongly associated with a great necessity for surgical treatment. The IIIa group was associated with increased drainage time, length of stay and complications. No mortality was observed. The selective use of PD and intrapleural fibrinolysis makes surgery unnecessary in more than 75% of cases.
  
  
  CONCLUSIONS
  The selective use of PD and fibrinolysis avoids surgery in more than 75% of cases. However, patients who require surgery have more complications, longer hospital stay, and more days on PD and they are more likely to require admittance to the Intensive Care Unit.
authors: Department of Thoracic Surgery, University Hospital of Gran Canaria Dr. Negrín, Canary Islands, Spain. prosu2001@yahoo.es
authors: Pedro
authors: P
authors: Rodríguez Suárez
authors: Jorge
authors: J
authors: Freixinet Gilart
authors: José María
authors: JM
authors: Hernández Pérez
authors: Mohamed
authors: M
authors: Hussein Serhal
authors: Antonio
authors: A
authors: López Artalejo
mesh_terms: D016724:Empyema, Pleural / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000473:pathology*; D010996:Pleural Effusion / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D011014:Pneumonia / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome