Early effective drainage in the treatment of loculated tuberculous pleurisy

Abstract

The role of early effective drainage in loculated tuberculous (TB) pleurisy treatment remains unclear.Consecutive patients with TB pleurisy subjected to anti-TB treatment and pigtail drainage (n564) were divided into three groups: 1) patients with free-flowing effusions irrigated with saline (free-flowing group; n520); 2) patients with loculated effusions irrigated with streptokinase (streptokinase group; n522); and 3) patients with loculated effusions irrigated with saline (saline group; n522). Pleural irrigation was performed for 3 days consecutively and the effusion drained as completely as possible. Outcomes were assessed for 12 months by clinical symptoms, effusion removed, radiological scores for effusion amount, lung function and occurrence of residual pleural thickening.The total effusion volumes removed were significantly greater in the free-flowing (2.36¡1.62 L) and streptokinase groups (2.59¡1.77 L) than in the saline group (1.28¡1.21 L). Compared with the saline group, the free-flowing and streptokinase groups showed significant improvement in radiological scores and forced vital capacity at different time-points during follow-up, and a significantly lower occurrence of residual pleural thickening. All outcome variables were comparable between the streptokinase and free-flowing groups.In summary, early effective drainage and complete anti-tuberculosis treatment may hasten clearance of pleural effusion, reduce residual pleural thickening occurrence and accelerate pulmonary function recovery in patients with symptomatic loculated tuberculous pleurisy.

Intrapleural Fibrinolytic Therapy for Treatment of Adult Parapneumonic Effusions and Empyemas

“…Thirteen were then retrieved for full text review. Five [21][22][23][24][25] were then excluded because the study population consisted of mainly tuberculous pleural effusions, and one 26 was excluded because it did not have a control arm (ie, placebo) ( Fig 1 ). Thus, seven studies 7,[9][10][11][27][28][29] were included in the fi nal analysis.…”

Pigtail Catheter Use for Draining Pleural Effusions of Various Etiologies

“…Chung et al [22] demonstrated that pigtail catheter insertion may hasten resolution of tuberculous pleural effusion and reduce the occurrence of residual pleural thickening. On the contrary, Lai et al [23] found that pigtail catheter insertion for cases of tuberculous pleural effusion had no beneficial effects on residual pleural thickening development and did not shorten the duration of fever.…”

Clinical Aspects of Adult Tuberculosis

“…There are insufficient data to support evidence-based recommendations regarding the use of adjunctive corticosteroids in the treatment of tuberculous pleurisy (Engel et al 2007;Light 2010). The early removal of pleural fluid may also reduce the long-term impact of residual pleural fibrosis (Chung et al 2008;Light 2010). …”