title: Repeated therapeutic thoracentesis to manage complicated parapneumonic effusions.
abstract: OBJECTIVE
  In complicated parapneumonic effusion (CPPE), antibiotics and evacuation of the infected pleural fluid are mandatory. The first-line evacuation treatment is still controversial. The aim of this article is to highlight the usefulness of repeated therapeutic thoracentesis (RTT) as a first-line treatment.
  
  
  RESULTS
  In the most recent study on RTT in CPPE, disposable pleural needles were used and the median number of thoracentesis was 3. The success rate was 81%, and only 4% of the patients were referred for thoracic surgery. The 1-year survival rate was 88%. On multivariate analysis, the observation of microorganisms in the pleural fluid after Gram staining and first thoracentesis volume at least 450 ml was associated with a higher risk of RTT failure. RTT is less invasive and can target different loculated pleural collections. Patients are less confined to beds between each procedure, and could even be ambulatory managed. The use of intrapleural fibrinolytics in association with DNase could most likely enhance the efficacy of RTT.
  
  
  CONCLUSIONS
  RTT is efficient and well tolerated in the management of CPPE, including pleural empyema, and could be proposed as a first-line therapy for CPPE. This technique could be used in association with intrapleural fibrinolytics and DNase.
authors.affiliation: aDepartment of Respiratory Medicine bIRSET UMR1085 cDepartment of Critical Care and Infectious Diseases, Pontchaillou Hospital, Rennes 1 University, Rennes, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Jouneau
authors.forename: Julien
authors.initials: J
authors.lastname: Letheulle
authors.forename: Benoit
authors.initials: B
authors.lastname: Desrues
mesh_terms: D000818:Animals; D004322:Drainage; D016724:Empyema, Pleural / Q000601:surgery; D006801:Humans; D010996:Pleural Effusion / Q000209:etiology; D015996:Survival Rate; D000069258:Thoracentesis; D015912:Thrombolytic Therapy