Parapneumonic Empyema Research Articles

A Homemade, High-fidelity Ultrasound Model for Simulating Pneumonia with Parapneumonic Effusion and Empyema.

Point-of-care ultrasonography (POCUS) is increasingly used for both diagnostic and guided procedures. Increasingly, POCUS has been used for identification of pneumonia and to assist in the differentiation of pleural effusions, as well as to guide thoracentesis. As such, there is a need for training with ideally high-fidelity lung ultrasound phantoms to ensure ultrasound proficiency and procedural competency. Unfortunately, most commercial ultrasound phantoms remain expensive and may have limited fidelity. Our aim was to create and describe a homemade, high-fidelity ultrasound phantom model for demonstrating pneumonia with pleural effusions for teaching purposes. An ultrasound phantom was constructed using a water-filled latex glove with a sliver of meat in it, covered over by a palm-sized piece of meat (skin and ribs are optional to increase ultrasonographic details and realism). This would appear like parapneumonic effusions with organized pneumonia under ultrasound examination. Creamer (or talc) can be added to the water in the glove to simulate empyema. The model can also be used to teach simple effusions and for ultrasound-guided thoracentesis and in clinical decision making. Easily prepared, homemade high-fidelity ultrasound phantom models for instructions on identification of pleural effusions and ultrasound-guided pleural tap of parapneumonic effusion were made.

Community-Acquired Pneumonia with Negative Chest Radiography Findings: Clinical and Radiological Features

Background: Data regarding community-acquired pneumonia (CAP) identified on chest computed tomography (CT) but not on chest radiography (CR) are limited. Objectives: The present study aimed to investigate the clinical and radiological features of these patients. Methods: We retrospectively compared the clinical characteristics, etiological agents, treatment outcomes, and CT findings between CAP patients with negative CR and positive CT findings (negative CR group) and those with positive CR as well as CT findings (control group). Results: Of 1,925 patients, 94 patients (4.9%) were included in the negative CR group. Negative CR findings could be attributed to the location of the lesions (e.g., those located in the dependent lung) and CT pattern with a low attenuation, such as ground-glass opacity (GGO). The negative CR group was characterized by a higher frequency of aspiration pneumonia, lower incidences of complicated parapneumonic effusion or empyema and pleural drainage, and lower blood levels of inflammatory markers than the control group. On CT, the negative CR group exhibited higher rates of GGO- and bronchiolitis-predominant patterns and a lower rate of consolidation pattern. Despite shorter length of hospital stay in the negative CR group, 30-day and in-hospital mortalities were similar between the two groups. Conclusions: CAP patients with negative CR findings are characterized by lower blood levels of inflammatory markers, a higher incidence of aspiration pneumonia, and a lower incidence of complicated para­pneumonic effusion or empyema than those with positive CR findings. Chest CT scan should be considered in suspected CAP patients with a negative CR, especially in bedridden patients.

Management of parapneumonic effusion and empyema

Parapneumonic effusions are pleural effusions that occur in the pleural space adjacent to a bacterial pneumonia. When bacteria invade the pleural space, a complicated parapneumonic effusion or empyema may result. Empyema is collection of pus in pleural cavity. If left untreated, complicated parapneumonic effusion/empyema leads to chronic encasement and pleural thickening. Simple parapneumonic effusions can be managed conservatively with appropriate antibiotics, but complicated parapneumonic effusions often require some kind of drainage along with antibiotics. Delay in treatment is associated with high morbidity and mortality. Clinically it is diagnosed with persistent fever, stony dull tender percussion, and absent breath sounds. Majority of cases are due to anaerobic infection. Gram-positive as well as Gram-negative organisms are also implicated. Many cases may have mixed organisms. Tuberculosis should be suspected if no organism is grown in empyema. Chest skiagram, thoracic ultrasound, and CT scan help in localization of effusion and detection of loculations. Confirmation is done by thoracocentesis and pleural fluid analysis, which shows exudate with polymorphonuclear leukocytosis. Management includes well-selected antibiotics and drainage by tube thoracostomy. Intrapleural fibrinolytics have been used in multiloculated complicated parapneumonic effusions with success. Advent of thoracoscopy and VATS has left very few cases requiring surgical decortication. Properly treated parapneumonic effusions have good prognosis.

Syndrome Evaluation System Contributes to Higher and Faster Pathogen Identification with Superior Clinical Correlation as Compared to Conventional Cultures in Patients with Empyema and Parapneumonic Effusions

Background & Objective: Pleural fluid culture is the standard of diagnosis for infectious etiology in parapneumonic effusion and empyema. However, the sensitivity is poor in tertiary centers due to prior antibiotic therapy. Newer nonculture-based molecular diagnostics are emerging as effective alternatives for microbial diagnosis. This prospective study evaluates the efficacy of Syndrome Evaluation System (SES), a multiplex molecular diagnostic test, in establishing the microbial etiology of empyema and clinical correlations of SES results with severity, interventions, and outcomes. Materials and Methods: Pleural fluid samples from 31 adult patients clinically diagnosed with empyema/complicated parapneumonic effusion were subjected to routine culture and SES. Routine laboratory tests, imaging, and antibiotic therapy were instituted as per standard care. Results: SES had 2.6-fold higher detection rate as compared to pleural fluid culture. A total of 16 samples (52%) were positive for pathogens on SES, whereas only six samples (20%) were positive on culture. SES was 83.33% concordant with culture. SES results were available within 24 h as compared to >72 h for culture. Prevalence of Gram-negative bacteria was 73.1%. SES positives were significantly associated with severity of disease and need to conduct more invasive procedures like thoracotomy and decortication. SES negatives had superior clinical outcomes compared to SES positives. Conclusion: SES has higher yield in microbial diagnosis compared to standard culture. It is sensitive, specific, and provides valuable information regarding a number of clinical correlates associated with empyema and complicated parapneumonic effusion. SES opens up new possibilities in understanding pathogenesis, management, and outcome in empyema.

Prospective evaluation of lung function in children with parapneumonic empyema.

Prospective studies that evaluated the outcome of childhood empyema are limited. To compare the outcome of pulmonary function in children with empyema. Children discharged with a diagnosis of empyema underwent a longitudinal study including measurement of pulmonary function and radiographic imaging. The population consisted of 39 patients, 24 males, and 15 females; with a median age of 4.6 years. Etiology was defined in 20/39 patients, and predominant microorganism was Streptococcus pneumoniae (19/20 isolates). Chest tube drainage with or without fibrinolytic agents was the primary intervention in 25 children. Video-assisted thoracoscopic surgery was performed in 14 and 5 children as primary and secondary intervention, respectively. Thirty-five children completed the lung function follow-up. At first follow-up visit, 5 out of 17 children able to perform spirometry (initially collaborating children) had normal tests, and 12 had mild-to-moderate defects of lung function that returned to normal over 2-57 months. Eighteen children unable to perform spirometry at first follow-up visit (initially non-collaborating children) had normal tests when they were evaluated 5-78 months postdischarge. At the end of the follow-up, all patients had normal lung function. Time to normalize did not differ between groups receiving different treatments (initially collaborating children, P = 0.064; initially non-collaborating children P = 0.223). Three previously healthy children had recurrent cough, and all children had normal chest radiographs aside from pleural thickening. The respiratory outcome in children with empyema is generally good and is not influenced by the type of intervention.

Morbidity and 30-day mortality after decortication for parapneumonic empyema and pleural effusion among patients in the Society of Thoracic Surgeons' General Thoracic Surgery Database

ObjectiveWe analyzed the Society of Thoracic Surgeons' Database to describe the results of surgical decortication. MethodsA review of patients undergoing pulmonary decortication, excluding hemothorax and malignancy, from 2009 to 2016 was performed. Preoperative factors, length of stay, discharge status, readmission, morbidity, and mortality were compared between open and video-assisted thoracoscopic surgery approaches. Multivariable models identified risk factors for morbidity and mortality. ResultsOf 7316 patients undergoing decortication, 6961 (95.2%) had a primary diagnosis of empyema. Video-assisted thoracoscopic surgery was used in 4435 patients (60.6%) and increased during the study period. Median length of stay was 4 days (interquartile range, 2-7) preoperatively and 7 days (interquartile range, 5-11) postoperatively. Mortality occurred in 228 patients (3.1%). Complications occurred in 2875 patients (39.3%), and major morbidity occurred in 1138 patients (15.6%). Transitional care after discharge occurred in 1922 patients (26.3%). Readmission within 30 days occurred in 452 patients (8.7%). Compared with video-assisted thoracoscopic surgery, mortality, major morbidity, prolonged length of stay, and discharge to other than home were higher with thoracotomy. In multivariable analysis, age, estimated glomerular filtration rate less than 60, chronic obstructive pulmonary disease, body mass index, American Society of Anesthesiologists level, Zubrod score, and thoracotomy were associated with increased mortality, morbidity, discharge to transitional care, and prolonged length of stay. Each additional preoperative hospital day (up to 5 days) increased mortality. Readmission, major morbidity, prolonged length of stay, and discharge to transitional care were all higher when preoperative hospitalization extended beyond 5 days. ConclusionsSurgeons participating in the Society of Thoracic Surgeons General Thoracic Surgery Database perform decortication for parapneumonic empyema and pleural effusion with limited mortality despite substantial postoperative morbidity. Further study is required to describe selection criteria for video-assisted thoracoscopic surgery and determine indications for surgical intervention to reduce delays in operative intervention.

Change in Bacterial Causes of Community-Acquired Parapneumonic Effusion and Pleural Empyema in Children 6 Years After 13-Valent Pneumococcal Conjugate Vaccine Implementation.

We describe here changes in the bacterial causes of pleural empyema before and after implementation of the 13-valent pneumococcal conjugate vaccine (PCV13) program in France (2009-2017). For 220 (39.3%) of 560 children, a bacterial cause was found. The frequency of pneumococcal infection decreased during the study from 79.1% in 2009 to 36.4% in 2017 (P < .001). Group A streptococcus is now the leading cause of documented empyema (45.5%).

RELATIONSHIP BETWEEN CLINICAL FEATURES AND CT FINDINGS IN HOSPITALIZED ADULT PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

SESSION TITLE: Chest Infections 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Data on the relationship between the clinical and microbiological features of community-acquired pneumonia (CAP) and its computed tomography (CT) findings are limited. The aim of the present study was to investigate the clinic-microbiological features of patients with CAP presenting with ground-glass opacity (GGO) and centrilobular nodules or tree-in-bud pattern on CT images. METHODS: Patients with CAP that underwent a CT scan at presentation were retrospectively classified using CT findings into consolidation, GGO, and bronchiolitis groups. These three groups were compared in terms of clinical parameters and microbiological data. RESULTS: Forty (2.4%) patients were allocated to the bronchiolitis group and 46 (2.8%) to the GGO group. The most common pathogen in the bronchiolitis group was Mycoplasma pneumoniae, which was significantly more frequently isolated in this group. The bronchiolitis group was characterized by a higher percentage of cough, a lower percentage of chest pain, and lower blood levels of inflammatory markers. Common pathogens in the GGO group were not significantly different from those in the other two groups. Unlike that observed in the consolidation group, complicated parapneumonic effusion or empyema was not observed in the bronchiolitis or GGO group. Outcome variables were similar in the three groups. CONCLUSIONS: The bronchiolitis group was characterized by a higher frequency of M. pneumoniae and a less severe form of CAP. The GGO and consolidation groups was similar with respect to causative microorganisms and the clinical features of CAP. No patient in the bronchiolitis or GGO group exhibited complicated parapneumonic effusion or empyema. CLINICAL IMPLICATIONS: 1) The bronchiolitis group was associated with a higher M. pneumoniae frequency, a less severe form of CAP, and the absence of complicated parapneumonic effusion or empyema. 2) The GGO group was similar to the consolidation group in terms of causative microorganisms, severity, and prognosis, but unlike the consolidation group, was not found to be associated with complicated parapneumonic effusion or empyema. 3) The bronchiolitis and GGO groups were similar to the consolidation group in terms of 30-day or in-hospital mortality and LOS. DISCLOSURES: No relevant relationships by Seung Ick Cha, source=Web Response No relevant relationships by Hyewon Seo, source=Web Response

Respiratory functional outcomes improvement with intervention in chronic empyema thoracis: a retrospective analysis.

Chronic pleural empyema is usually a consequence of in adequate treatment of acute pleural empyema. The incidence of tubercular and post-intervention empyema has increased in underdeveloped or developing countries adding to economic burden on the society. We have performed a retrospective analysis on role of intervention in chronic empyema to improve respiratory functional outcomes. We retrospectively reviewed data of 115 patients of chronic tubercular and parapneumonic empyema thoracis to evaluate change in functional outcome parameters based on their treatment modalities during follow-up in department of surgery, King George's Medical University, Lucknow, India. Accordingly, four groups were made-group 1 (tube thoracostomy), group 2 (decortication by video-assisted thoracoscopic surgery (VATS)), group 3 (decortication by open thoracotomy), and group 4 (window thoracostomy followed by thoracomyoplasty). Significant improvement was noted in forced expiratory volume in one second (FEV1)% and forced vital capacity (FVC)% in all groups. In spirometry, percent change in mean FEV1 from pre-intervention to post-intervention was increase of 55.4%, 38.3%, 47.2, and 59.21% in group 1, group 2, group 3, and group 4 respectively, and percent change in mean FVC from pre-intervention to post-intervention was increase of 53.30%, 38.11%, 51.23, and 54.21% in group 1, group 2, group 3, and group 4 respectively. Our study showed that a significant increase was observed in FVC and FEV1 from pre to post among all the groups. Comparable improvement of functional outcomes with non-operative intervention in properly selected patients can be achieved.

Risk Stratification in Patients with Complicated Parapneumonic Effusions and Empyema Using the RAPID Score

Complicated parapneumonic effusions and empyema are a leading cause of morbidity in the United States with over 1million admissions annually and a mortality rate that remains high in spite of recent advances in diagnosis and treatment. The identification of high risk patients is crucial for improved management and the provision of cost-effective care. The RAPID score is a scoring system comprised of the following variables: renal function, age, purulence, infection source, and dietary factors and has been shown to predict outcomes in patients with pleural space infections. In a single center retrospective study, we evaluated 98 patients with complicated parapneumonic effusions and empyema who had tube thoracostomy (with or without Intrapleural fibrinolytic therapy) and assessed treatment success rates, mortality, length of hospital stay, and direct hospitalization costs stratified by three RAPID score categories: low-risk (0-2), medium risk (3-4), and high-risk (5-7) groups. Treatment success rate was 71%, and the 90day mortality rate was 12%. There was a positive-graded association between the low, medium and high RAPID score categories and mortality, (5.3%, 8.3% and 22.6%, respectively), length of hospital stay (10, 21, 19 days, respectively), and direct hospitalization costs ($19,909, $36,317 and $43,384, respectively). Our findings suggest that the RAPID score is a robust tool which could be used to identify patients with complicated parapneumonic effusions and empyema who may be at an increased risk of mortality, prolonged hospitalization, and who may incur a higher cost of treatment. Randomized controlled trials identifying the most effective initial treatment modality for medium- and high-risk patients are needed.

Video-Assisted Thoracoscopic Surgery of Parapneumonic Empyema - a 10-year Single-Centre Experience.

Evaluation of a standardised management for the treatment of patients with parapneumonic empyema. A retrospective 10-year single-centre analysis of all patients with parapneumonic empyema undergoing a standardised thoracoscopic treatment approach. We describe referral and age patterns, microbiological results, overall and stage-dependent success rates, conversion rates, 30-day and in-hospital mortality. From May 2003 to April 2013, 248 patients with parapneumonic empyemas were treated in our centre. Most patients were referred at weekends, and younger patients had advanced stages. The cure rate in stage I was 97.6 % and reached 80.3 % in stage II and 63.1 % in stage III. 6 patients (2.4 %) (all stage III) needed conversion to an open procedure. A revision was required in 19.7 % of cases in stage II and 27.7 % in stage III. 30-day mortality was 4.8 %, in-hospital mortality was 8.1 %. A standardised approach, including VATS, is associated with a high cure, low revision and moderate conversion rates. In view of a still considerable mortality, a higher index of suspicion and detection of advanced stages, especially in younger patients, is required to improve outcomes.

Features of Parapneumonic Effusions.

Abstract Introduction: Parapneumonic effusions, as a complication of community-acquired pneumonia (CAP), usually have a good course, but they sometimes progress into complicated parapneumonic effusion (CPPE) and empyema, thus becoming a significant clinical problem. Aim: To review clinical and radiological features, as well as diagnostic and therapeutic options in parapneumonic effusions. Material and methods: The analysis included 94 patients with parapneumonic effusion hospitalized at the University Infectious Diseases Clinic in Skopje during a 4 year period. Out of 755 patients with CAP, 175 (23.18%), had parapneumonic effusion. Thoracentesis was performed in 94 (53.71%) patients, 50 patients were with uncomplicated parapneumonic effusions (UCPPE) and 44 with complicated parapneumonic effusions (CPPE). Results: More patients (59.57%) were male; the average age was 53.82±17.5 years. The most common symptoms included: fever (91; 96.81%), cough (80; 85.11%), pleuritic chest pain (68; 72.34%), dyspnea (65; 69.15%). Alcoholism was the most common comorbidity registered in 12 (12.77%) patients. Macroscopically, effusion was yellow and clear in most cases (36; 38.29%). Localization of pleural effusion was often in the left costophrenic angle (53; 56.38%) and ultrasonographic non-septated complex. Between the two groups of effusions there was a significant difference between the ERS, WBC and CRP in serum and CRP in pleural fluid. Statistical difference existed in terms of days of hospitalization with a longer hospital stay for patients with CPPE (p &lt;0.0001). Conclusion: Patients with parapneumonic effusion have the symptoms of acute respiratory infection and frequent accompanying diseases. Future diagnostic and therapeutic treatment depends on pleural fluid features and imaging lung findings.

Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children \u2013 16-year, single-centre experience of radiologically placed drains

BackgroundChest tube drainage with fibrinolytics is a cost-effective treatment option for parapneumonic effusion and empyema in children. Although the additional use of ultrasound (US) guidance is recommended, this is rarely performed in real time to direct drain insertion.ObjectiveTo evaluate the effectiveness and safety of real-time US-guided, radiologically placed chest drains at a tertiary university hospital.Materials and methodsThis was a retrospective review over a 16-year period of all children with parapneumonic effusion or empyema undergoing percutaneous US-guided drainage at our centre.ResultsThree hundred and three drains were placed in 285 patients. Treatment was successful in 93% of patients after a single drain (98.2% success with 2 or 3 drains). Five children had peri-insertion complications, but none was significant. The success rate improved with experience. Although five patients required surgical intervention, all children treated since 2012 were successfully treated with single-tube drainage only and none has required surgery.ConclusionOur technique for inserting small-bore (≤8.5 F) catheter drains under US guidance is effective and appears to be a safe procedure for first-line management of complicated parapneumonic effusion and empyema.

Relationship Between Clinical Features and Computed Tomographic Findings in Hospitalized Adult Patients With Community-Acquired Pneumonia

BackgroundData on the relationship between the clinical and microbiological features of community-acquired pneumonia (CAP) and its computed tomography (CT) findings are limited. The aim of the present study was to investigate the clinic-microbiological features of patients with CAP presenting with ground-glass opacity (GGO) and centrilobular nodules or tree-in-bud pattern on CT images. MethodsPatients with CAP who underwent a CT scan at presentation were retrospectively classified using CT findings into consolidation, GGO and bronchiolitis groups. These 3 groups were compared in terms of clinical parameters and microbiological data. ResultsA total of 40 patients (2.4%) were allocated to the bronchiolitis group and 46 (2.8%) to the GGO group. The most common pathogen in the bronchiolitis group was Mycoplasma pneumoniae, which was significantly more frequently isolated in this group. The bronchiolitis group was characterized by a higher percentage of cough, a lower percentage of chest pain and lower blood levels of inflammatory markers. Common pathogens in the GGO group were not significantly different from those in the other 2 groups. Unlike that observed in the consolidation group, complicated parapneumonic effusion or empyema was not observed in the bronchiolitis or GGO group. Outcome variables were similar in the 3 groups. ConclusionsThe bronchiolitis group was characterized by a higher frequency of M. pneumoniae and a less severe form of CAP. The GGO and consolidation groups was similar with respect to causative microorganisms and the clinical features of CAP. No patient in the bronchiolitis or GGO group exhibited complicated parapneumonic effusion or empyema.

Factors Affecting Postoperative Lung Expansion in Patients with Pyogenic Empyema.

In patients with parapneumonic empyema, decortication is usually preferred to ensure functional lung re-expansion. However, there could be patients exhibiting incomplete postoperative lung expansion and inadequate drainage despite decortication. Therefore, we evaluated factors affecting postoperative lung expansion in patients undergoing decortication. A total of 221 patients with pyogenic empyema who underwent video-assisted thoracoscopic surgery (VATS) between January and October 2016 in our hospital were reviewed in terms of surgical success. The following factors were evaluated: age; the time between identification of a localized effusion and surgical referral; chest tube drainage durations; any underlying morbidity preoperative blood culture data; and the thickness of the visceral pleura. Several factors that significantly prolonged the postoperative time to lung expansion were evident in patients with diabetes mellitus (DM) and bacteremia; postoperative chest tube drainage was significantly longer in those with DM (p = 0.009) and bacteremia (p = 0.01); and postoperative hospitalization time was significantly longer in patients with bacteremia (p = 0.01). The thickness of the visceral pleura was strongly correlated with postoperative chest tube drainage duration and postoperative hospitalization time (Pearson correlation coefficient, r = 0.245, p = 0.00). In patients with DM, bacteremia, or thickened pleura, the time to lung expansion after operation was longer. Therefore, stricter pre- and post-operative control of blood-sugar levels and adequate antibiotics are required to facilitate postoperative lung re-expansion. In patients with thickened pleurae, prolonged chest tube placement is unavoidable.

Rethinking the Doses of Tissue Plasminogen Activator and Deoxyribonuclease Administrated Concurrently for Intrapleural Therapy for Complicated Pleural Effusion and Empyema.

BackgroundComplicated parapneumonic effusions empyema (CPEE) is fairly common and associated with increased morbidity and mortality. The Multicenter Intrapleural Sepsis Trial 2 (MIST 2) established the combination of intrapleural deoxyribonuclease (DNase) and tissue plasminogen activator (tPA) as an effective treatment for CPEE, thereby avoiding surgery and decreasing the length of hospitalization. MIST 2, however, used a labor-intensive protocol with some risk of bleeding. We hypothesize the simpler regimen of concurrent administration of intrapleural tPA and DNase (lower dose of tPA and a higher DNAse dose) to be equally effective with a decreased risk of bleeding.MethodsRetrospective analysis of the concurrent administration of intrapleural tPA and DNase for CPEE during November 2014 to February 2016 was done at a tertiary care center. The inclusion criteria included 1) pleural fluid with any of the following: (a) exudative and loculated effusion in a patient with pneumonia, (b) gram stain/culture positive, (c) macroscopically purulent 2) chest tube placement during current hospitalization 3) concurrent administration of intrapleural tPA and DNase (4mg and 10mg per instillation respectively). The exclusion criteria was 1) chest tube placement prior to current hospitalization and 2) age < eighteen.ResultsSeventeen patients received concurrent tPA and DNase therapy for CPEE in the study period. Two had chest tubes placed prior to current hospitalization and were excluded. Twelve patients (80%) were successfully discharged with clinical resolution of CPEE with medical therapy. One (7%) patient required surgery. No mortality due to pleural sepsis was noted. The median number of concurrent tPA and DNase treatment was two. Median cumulative tPA dose was 8 mg (mean: 14.1±17 mg) and median cumulative DNase dose was 20mg (mean: 19.7 ± 12.2 mg). The median dwell time for the chest tubes was 8.5 days. Our regimen had similar success when compared to MIST 2 and allowed for lesser treatments and cumulative doses. No complication of intrapleural therapy with hemorrhagic conversion of CPEE, or worsening pain leading to discontinuation of therapy was noted.ConclusionThe concurrent administration of intrapleural therapy at lower doses than the current standard MIST 2 protocol is practical, efficient and effective. We suggest a higher DNase dose with a lower tPA dose which may further decrease hemorrhagic complications. Further randomized trials are required to establish the optimal dose of intrapleural therapy for CPEE.

TPA/DNase for Complicated Parapneumonic Effusions and Empyemas

tPA/DNase for Complicated Parapneumonic Effusions and Empyemas

Minimally invasive treatment of complicated parapneumonic effusions and empyemas in adults.

To summarize the evidence underlying the non-surgical management of patients with complicated parapneumonic effusions (CPPE) or empyemas. All articles published in PubMed according to their relevance with the subject were identified. There is a lack of powered randomized controlled studies comparing medical and surgical approaches to CPPE/empyemas in adults. In addition to antibiotics for an unspecified period of time, CPPE/empyemas can initially be treated with a therapeutic thoracentesis (which can be repeated if necessary), the insertion of a small-bore chest catheter under ultrasound guidance, or the administration through the catheter of fibrinolytics alone, saline alone or fibrinolytics in combination with either saline or deoxyribonuclease. These conservative measures resolve more than 90% of the cases, thus making a rescue surgery unnecessary.

Evolution Of Practice in Surgical Management of Parapneumonic Effusion and Empyema

Evolution Of Practice in Surgical Management of Parapneumonic Effusion and Empyema

Infectious pleural effusion status and treatment progress.

Pleural cavity infection continuously seriously threatens human health with continuous medical progress. From the perspective of pathophysiology, it can be divided into three stages: exudative stage, fibrin exudation and pus formation stage, and organization stage. Due to the pathogenic bacteria difference of pleural cavity infection and pulmonary infection, it is very important for disease treatment to analyze the bacteria and biochemical characteristics of the infectious pleural effusion. Most prognoses of patients have been relatively good, while for some patients, the complicated parapneumonic effusion or empyema could be evolved. Antibiotic treatment and sufficient drainage are the foundation for this treatment. No evidence can support the routine use of a fibrin agent. However, it has been reported that the plasminogen activator and deoxyribonuclease can be recommended to be applied in the pleural cavity. In case of failure on conservative medical treatment, operative treatment can be applied such as thoracoscopy and pleural decortication. According to the clinical characteristics of these patients, it is a key to research prognosis, as well as early evaluation and stratification, in the future.