title: Management of Parapneumonic Pleural Effusion in Adults.
abstract: Pleural infections have high morbidity and mortality, and their incidence in all age groups is growing worldwide. Not all infectious effusions are parapneumonic and, in such cases, the organisms found in the pleural space are not the same as those observed in lung parenchyma infections. The diagnostic difficulty lies in knowing whether an infectious effusion will evolve into a complicated effusion/empyema, as the diagnostic methods used for this purpose provide poor results. The mainstays of treatment are to establish an early diagnosis and to commence an antibiotic regimen and chest drain as soon as possible. This should preferably be carried out with fine tubes, due to certain morphological, bacteriological and biochemical characteristics of the pleural fluid. Fluid analysis, particularly pH, is the most reliable method for assessing evolution. In a subgroup of patients, fibrinolytics may help to improve recovery, and their combination with DNase has been found to obtain better results. If medical treatment fails and surgery is required, video-assisted thoracoscopic surgery (VATS) is, at least, comparable to decortication by thoracotomy, so should only undertaken if previous techniques have failed. Further clinical trials are needed to analyze factors that could affect the results obtained, in order to define new evidence-based diagnostic and therapeutic strategies that provide more effective, standardized management of this disease.
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España.
authors.forename: Lucía
authors.initials: L
authors.lastname: Ferreiro
authors.affiliation: Servicio de Análisis Clínicos, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, España.
authors.forename: María Esther
authors.initials: ME
authors.lastname: San José
authors.affiliation: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, España. Electronic address: luis.valdes.cuadrado@sergas.es.
authors.forename: Luis
authors.initials: L
authors.lastname: Valdés
mesh_terms: D000465:Algorithms; D006801:Humans; D010996:Pleural Effusion / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*
keywords: Análisis del líquido pleural; Chest drainage; Complicated parapneumonic pleural effusion; Cultivo del líquido pleural; Culture of pleural fluid; Derrame pleural paraneumónico; Derrame pleural paraneumónico complicado; Drenaje torácico; Empiema; Empyema; Fibrinolíticos intrapleurales; Intrapleural fibrinolytics; Parapneumonic pleural effusion; Pleural fluid analysis; Thoracoscopy; Toracoscopia