Parapneumonic pleural effusion and empyema
Date
2008
Authors
Koegelenberg C.F.N.
Diaconi A.H.
Bolligeri C.T.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
At least 40% of all patients with pneumonia will have an associated pleural effusion, although a minority will require an intervention for a complicated parapneumonic effusion or empyema. All patients require medical management with antibiotics. Empyema and large or loculated effusions need to be formally drained, as well as parapneumonic effusions with a pH <7.20, glucose <3.4 mmol/l (60 mg/dl) or positive microbial stain and/or culture. Drainage is most frequently achieved with tube thoracostomy. The use of fibrinolytics remains controversial, although evidence suggests a role for the early use in complicated, loculated parapneumonic effusions and empyema, particularly in poor surgical candidates and in centres with inadequate surgical facilities. Early thoracoscopy is an alternative to thrombolytics, although its role is even less well defined than fibrinolytics. Local expertise and availability are likely to dictate the initial choice between tube thoracostomy (with or without fibrinolytics) and thoracoscopy. Open surgical intervention is sometimes required to control pleural sepsis or to restore chest mechanics. This review gives an overview of parapneumonic effusion and empyema, focusing on recent developments and controversies. Copyright © 2008 S. Karger AG.
Description
Keywords
amoxicillin plus clavulanic acid, carbapenem derivative, cefepime, ceftazidime, cefuroxime, cephalosporin derivative, clindamycin, fibrinolytic agent, linezolid, metronidazole, piperacillin plus tazobactam, streptokinase, tissue plasminogen activator, urokinase, vancomycin, antibiotic therapy, computer assisted tomography, echography, empyema, monotherapy, pathogenesis, pleura effusion, pneumonia, priority journal, review, risk factor, thoracocentesis, thoracoscopy, thorax drainage, thorax radiography, Anti-Bacterial Agents, Chest Tubes, Diagnostic Imaging, Drainage, Empyema, Pleural, Fibrinolytic Agents, Humans, Pleural Effusion, Pneumonia, Punctures, Risk Factors, Streptokinase, Thoracoscopy, Thoracostomy, Thrombolytic Therapy, Tissue Plasminogen Activator, Urinary Plasminogen Activator
Citation
Respiration
75
3
75
3