Parapneumonic pleural effusion and empyema

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dc.contributor.authorKoegelenberg C.F.N.
dc.contributor.authorDiaconi A.H.
dc.contributor.authorBolligeri C.T.
dc.date.accessioned2011-05-15T16:17:50Z
dc.date.available2011-05-15T16:17:50Z
dc.date.issued2008
dc.description.abstractAt 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.
dc.description.versionReview
dc.identifier.citationRespiration
dc.identifier.citation75
dc.identifier.citation3
dc.identifier.issn00257931
dc.identifier.other10.1159/000117172
dc.identifier.urihttp://hdl.handle.net/10019.1/14392
dc.subjectamoxicillin plus clavulanic acid
dc.subjectcarbapenem derivative
dc.subjectcefepime
dc.subjectceftazidime
dc.subjectcefuroxime
dc.subjectcephalosporin derivative
dc.subjectclindamycin
dc.subjectfibrinolytic agent
dc.subjectlinezolid
dc.subjectmetronidazole
dc.subjectpiperacillin plus tazobactam
dc.subjectstreptokinase
dc.subjecttissue plasminogen activator
dc.subjecturokinase
dc.subjectvancomycin
dc.subjectantibiotic therapy
dc.subjectcomputer assisted tomography
dc.subjectechography
dc.subjectempyema
dc.subjectmonotherapy
dc.subjectpathogenesis
dc.subjectpleura effusion
dc.subjectpneumonia
dc.subjectpriority journal
dc.subjectreview
dc.subjectrisk factor
dc.subjectthoracocentesis
dc.subjectthoracoscopy
dc.subjectthorax drainage
dc.subjectthorax radiography
dc.subjectAnti-Bacterial Agents
dc.subjectChest Tubes
dc.subjectDiagnostic Imaging
dc.subjectDrainage
dc.subjectEmpyema, Pleural
dc.subjectFibrinolytic Agents
dc.subjectHumans
dc.subjectPleural Effusion
dc.subjectPneumonia
dc.subjectPunctures
dc.subjectRisk Factors
dc.subjectStreptokinase
dc.subjectThoracoscopy
dc.subjectThoracostomy
dc.subjectThrombolytic Therapy
dc.subjectTissue Plasminogen Activator
dc.subjectUrinary Plasminogen Activator
dc.titleParapneumonic pleural effusion and empyema
dc.typeReview
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