HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Panagiotis Misthos Evangelos Sepsas Kalliopi Athanassiadi Achilles Lioulias Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Misthos, P. Articles by Lioulias, A. Search for Related Content PubMed PubMed Citation Articles by Misthos, P. Articles by Lioulias, A. Related Collections Pleura

Eur J Cardiothorac Surg 2005;28:599-603
© 2005 Elsevier Science NL

Original articles

Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study

Thoracic Surgical Department, General Hospital for Chest Diseases ‘SOTIRIA’, 7 Dimitrakopoulou Street, 11141 Athens, Greece

Received 10 May 2005; received in revised form 3 July 2005; accepted 7 July 2005.

^* Corresponding author. Tel./fax: +30 2102529048. (Email: panmisthos{at}yahoo.gr).

Abstract

Objective: A prospective randomized study was conducted in order to analyze the role of fibrinolytics in the treatment of complicated parapneumonic effusion. Methods: From 2001 to 2004, 127 consecutive patients were managed for thoracic empyema. In all cases the cause was bacterial pneumonia. Seventy patients were managed with sole tube thoracostomy (group A) and 57 with combination of tube thoracostomy and streptokinase instillation (group B). Groups were statistically compared for the age, gender, duration of symptoms, quality of pleural fluid, chest imaging, complete drainage, length of hospital stay and mortality. Multivariate analysis was used in order to define the factors that affect outcome. Results: Tube thoracostomy was successful in 47 (67.1%) cases (group A), while fibrinolysis led to a favorable outcome in 50 cases (87.7%) (P<0.05). The length of stay in thoracic surgical department was significantly longer for group A (P<0.001). Mortality rate in group A was significantly higher (P<0.001). Multiple regression analysis disclosed as sole independent favorable factor for pleural drainage, the use of fibrinolysis during the course of chest tube drainage (P=0.006, odds ratio 4.29, 95% CI 1.51–12.14). Conclusions: Fibrinolytic agents are a useful adjunct in the management of complicated parapneumonic effusions. Intrapleural fibrinolytics, if used early in the fibrinopurulent stage of a parapneumonic effusion, decrease the rate of surgical interventions (VATS or open decortcation) and the length of hospital stay with minor associated morbidity.

Key Words: Thoracic empyema • Chest tube thoracostomy • Fibrinolysis

This article has been cited by other articles:

				D. A. Gervais, D. A. Levis, P. F. Hahn, R. N. Uppot, R. S. Arellano, and P. R. Mueller Adjunctive Intrapleural Tissue Plasminogen Activator Administered via Chest Tubes Placed with Imaging Guidance: Effectiveness and Risk for Hemorrhage Radiology, March 1, 2008; 246(3): 956 - 963. [Abstract] [Full Text] [PDF]

				T. F. Molnar Current surgical treatment of thoracic empyema in adults Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 422 - 430. [Abstract] [Full Text] [PDF]