Prise en charge des épanchements parapneumoniques compliqués : état des lieux des pratiques en France

Abstract

There are no French guidelines for the management of complicated parapneumonic effusions. A national observational study was carried out to assess the main features of current clinical practice for this condition. A questionnaire was sent by email to the 1500members of the Société de Pneumologie de Langue Française (SPLF) between 15thNovember and 15thDecember2012. There were 92responders, i.e. a response rate of 6%. Of these, 87physicians mentioned that they were involved in the management of patients with complicated parapneumonic effusions with a median number of cases of 10per year (IQR: 5-20). Chest tube drainage was the main approach used for pleural fluid aspiration (n=51/87), followed by repeated thoracentesis (n=29/87) and early surgery (1/87). Five physicians answered both chest tube drainage or repeated thoracentesis and one physician either chest tube drainage or early surgery. Pleural fibrinolytics were never used by 20% of physicians, only in case of loculations by 70% and by 10% of respondents in all cases. Only 3physicians combined fibrinolytics with DNAse. A double antibiotic dose was used by one third of physicians. All the physicians used respiratory physiotherapy during hospitalization and to aid recovery. Follow-up practices were heterogeneous. The management of complicated parapneumonic effusions varies significantly in France. National guidelines may be helpful to define best practice and aid in its implementation.