The Use of Trypsin in Chest Disease

Abstract

The use of tryptic debridement in fibrinopurulent empyema is definitely indicated. It quickly removes the pyogenic membrane, decreases the viscosity of the fluid, and in a high percentage of cases sterilizes the space. It thus prepares patients ideally for surgical decortication or resection. In cases of less than six months' duration, tryptic debridement alone may be expected to expand the lung in 65 per cent. It is effective in both tuberculous and non-tuberculous empyema. The incidence of side effects in the nature of histamine-like reaction are few and of minor importance. Complete protection is offered by concomitant anti-histamine therapy. There have been no harmful results, and only one case of 17 is classed as a complete failure. Trypsin can be conveniently packaged, easily handled, and used with a minimum amount of waste. The use of tryptic debridement in post-traumatic clotted chest will supplant surgical decortication. It can be used in postoperative empyema without fear of damaging the process of tissue repair. Its use in the presence of bronchopleural fistula is not contraindicated. Results thus far obtained warrant a continued investigation of the use of aerosol trypsin in cases associated with copious, tenacious and purulent sputum.