title: Iterative thoracentesis as first-line treatment of complicated parapneumonic effusion.
abstract: BACKGROUND
  Optimal management of complicated parapneumonic effusions (CPPE) remains controversial.
  
  
  OBJECTIVE
  to assess safety and efficacy of iterative therapeutic thoracentesis (ITTC), the first-line treatment of CPPE in Rennes University Hospital.
  
  
  METHODS
  Patients with CPPE were identified through our computerized database. We retrospectively studied all cases of CPPE initially managed with ITTC in our institution between 2001 and 2010. ITTC failure was defined by the need for additional treatment (i.e. surgery or percutaneous drainage), or death.
  
  
  RESULTS
  Seventy-nine consecutive patients were included. The success rate was 81% (n = 64). Only 3 patients (4%) were referred to thoracic surgery. The one-year survival rate was 88%. On multivariate analysis, microorganisms observed in pleural fluid after Gram staining and first thoracentesis volume ≥450 mL were associated with ITTC failure with adjusted odds-ratios of 7.65 [95% CI, 1.44-40.67] and 6.97 [95% CI, 1.86-26.07], respectively. The main complications of ITTC were iatrogenic pneumothorax (n = 5, 6%) and vasovagal reactions (n = 3, 4%). None of the pneumothoraces required chest tube drainage, and no hemothorax or re-expansion pulmonary edema was observed.
  
  
  CONCLUSIONS
  Although not indicated in international recommendations, ITTC is safe and effective as first-line treatment of CPPE, with limited invasiveness.
authors.affiliation: Respiratory medicine department, Pontchaillou Hospital, Rennes 1 University, Rennes, France ; Infectious diseases and intensive care unit, Pontchaillou Hospital, Rennes 1 University, Rennes, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Letheulle
authors.affiliation: Infectious diseases and intensive care unit, Pontchaillou Hospital, Rennes 1 University, Rennes, France ; INSERM U835, Rennes 1 University, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: Department of medical information, Pontchaillou Hospital, Rennes 1 University, Rennes, France.
authors.forename: Lauren
authors.initials: L
authors.lastname: Saunders
authors.affiliation: Respiratory medicine department, Pontchaillou Hospital, Rennes 1 University, Rennes, France.
authors.forename: Mallorie
authors.initials: M
authors.lastname: Kerjouan
authors.affiliation: Respiratory medicine department, Pontchaillou Hospital, Rennes 1 University, Rennes, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Léna
authors.affiliation: Respiratory medicine department, Pontchaillou Hospital, Rennes 1 University, Rennes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Desrues
authors.affiliation: Infectious diseases and intensive care unit, Pontchaillou Hospital, Rennes 1 University, Rennes, France ; CIC -INSERM 0203Rennes 1 University, Rennes, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Le Tulzo
authors.affiliation: Respiratory medicine department, Pontchaillou Hospital, Rennes 1 University, Rennes, France ; IRSET U1085, Rennes 1 University, Rennes, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Jouneau
mesh_terms: D000368:Aged; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D011183:Postoperative Complications; D011379:Prognosis; D016896:Treatment Outcome; D014463:Ultrasonography