Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis

Tk, Lim; Chin, N K

doi:10.1183/09031936.99.13351499

Cited by 73 publications

(51 citation statements)

References 24 publications

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“…We also found that hospitalization was significantly longer in patients requiring pleural drainage or decortication. This fi nding contrasts with other publications in which decreases in hospital stay were registered after surgical treatment with or without associated instillation of intrapleural fi brinolytics [18][19][20] . The reason for this difference may reside in the fact that decortication was performed earlier in these previous publications, whereas in our patients it was done after other therapies had failed (median 22.6 days).…”

Section: Discussioncontrasting

confidence: 54%

Factors Influencing Length of Hospital Stay in Patients with Bacterial Pleural Effusion

Soriano¹,

Alegre²,

Alemán³

et al. 2005

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Background: Factors influencing length of hospital stay have been poorly analyzed in parapneumonic pleural effusions (PPE). Objectives: The aim of this work is to identify the variables that determine increased hospital stay in patients with infectious pleural effusion (PE). Patients and Methods: We analyzed 112 patients with PE: empyema, complicated parapneumonic and non-complicated parapneumonic. Epidemiologic, biochemical, therapeutic and radiological variables were analyzed. Correlations with hospital stay were studied using the Student’s t test, analysis of variance, Mann-Whitney U-test and linear regression model. Results: Among the 112 patients studied, there were 32 empyema, 50 complicated and 30 non-complicated parapneumonic cases. The median of length stay for all patients was 17 days. Longer hospitalization was required in patients with empyemic PE (p = 0.015), patients with underlying diseases (p = 0.003), those needing pleural drainage (p = 0.005) or decortication (p = 0.043) and those presenting unfavorable radiological outcome after treatment (p = 0.02). Biochemical parameters associated with longer hospital stay were elevated pleural fluid polymorphonuclear elastase (p = 0.001, r = 0.307) and lactate dehydrogenase (p = 0.001, r = 0.312). After linear regression analysis, only underlying disease, pleural drainage and pleural fluid polymorphonuclear elastase values remained in the model, explaining 23.1% of the variability of days of hospitalization. Conclusions: The patients with PPE and empyema who required longer hospitalization were those with purulent fluid, underlying disease, surgical drainage and/or decortication, with unfavorable radiological outcome and higher pleural fluid levels of lactate dehydrogenase and polymorphonuclear elastase.

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Section: Discussioncontrasting

confidence: 54%

Factors Influencing Length of Hospital Stay in Patients with Bacterial Pleural Effusion

Soriano¹,

Alegre²,

Alemán³

et al. 2005

Respiration

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“…The six-dose regimen, in which a total of 1.5 million units of streptokinase is administered, represents more doses and a larger total dose of the drug than the regimens used in earlier studies examining intermediate surrogate end points, which had positive results. 8,10,13 Finally, the overall combined rate of death or the need for surgery was similar to that in previous studies, 2,5,16,17 suggesting that our study population was representative.…”

Section: Subgroup Analysessupporting

confidence: 70%

U.K. Controlled Trial of Intrapleural Streptokinase for Pleural Infection

2005

N Engl J Med

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“…According to studies, early surgical intervention (VATS or thoracotomy) can reduce complication rates and shorten healing process in the following clinical conditions: patients without clinical improvement despite tube drainage or tube and IPFT treatment; those with persistent fever and leukocytosis; patients with ongoing loculations in the imaging; and those without any improvement in the amount of pleural fluid (2,3,16,17,18). In our study, we applied decortication to 3 and VATS to 4 patients.…”

Section: Discussionmentioning

confidence: 99%

Intrapleural Fibrinolytic Treatment: Management of 85 Cases

Ulutaş¹,

Çelik²,

Kuzucu³

2015

J Turgut Ozal Med Cent

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Objective: Fibrous cortex developes over the lung in 7-10 days if the benign or malign pleural effusion consisting of blood, coagulum or empyema could not be drained. Thus, clinical conditions like trapped lung, restrictive lung disease, or dyspnea may appear as a result of fibrinous pleuritis. Both streptokinase and tissue plasminogen activator (tPA) are involved in the breakdown of proteins and fibrin. Hence, intrapleural fibrinolytic treatment (IPFT) may prevent invazive procedures by avoiding fibrous cortex develepment if it is applied at a proper time. Materials and Methods: Eighty five cases undergoing IPFT by tube or catheter thoracostomies between 2003-2013 are evaluated retrospectively. Patients have been evaluated according to age, symptoms, diagnosis, and response to treatment. Results: The mean age of the patients was 45.5 (65 males and 20 females). IPFT was performed in 30 patients with empyema, and in 20 and 13 patients due to postoperative or posttraumatic organised hematomas, respectively. Eleven patients underwent IPFT for loculated benign pleural effusions while 9 patients recieved the treatment for loculated malign pleural effusions. Complicated hydropneumothorax was the indication for IPFT in 2 patients. A total of sixty patients received tube thoracostomy while 25 patients underwent catheter thoracostomy. Tree patients had decortication and 4 underwent video assisted thoracoscopic (VATS) drainage due to failure of IPFT. Aseptic pleural space remained in 12 patients at the end of our study. One of the patients required blood transfusion and additional medical treatment for intrapleural hemorrhage secondary to the local absorption of the IPFT. Conclusion: IPFT is a safe, effective treatment which can be performed prior to much invasive surgical procedures in patients with loculated empyema, clotted hemothorax, or postoperative hematoma, and benign or malign pleural effusions which can not be drained due to high fibrinous contents. Key Words: Intrapleural; Streptokinase; Tissue Plasminogen Activator. İntraplevral Fibrinolitik Tedavi Uygulamaları: 85 Olguluk Seri SunumuÖzet: Amaç: Komplike plevral efüzyonlarda sadece tüp ve katater torakostomi ile sıvıyı drene etmek her zaman mümkün olmaz. Drene edilemeyen kan, pıhtı, ampiyem, benign veya malign plevral sıvılarda 7-10 gün içinde akciğer üzerinden fibröz bir kabuk oluşmaya başlar. Bu durum ise tuzaklanmış akciğer ve akciğer restriksiyonu, sekonder ampiyem ve dispne ile sonuçlanır. Streptokinaz yada Tissue Plazminojen Activatörü (tPA), fibrin ve diğer bazı proteinleri parçalayarak etki etmekte olup uygun zamanda yapılan fibrinolitik tedavi ile bu süreç kesintiye uğratılıp, akciğer üzerinde fibröz kabuk gelişimi önlenerek hasta daha invaziv işlemlerden kurtarılabilir. Gereç ve Yöntemler: Bu çalışmada 2003-2013 yılları arasında tüp yada kateter torakostomisi ile intraplevral fibrinolitik tedavi (IPFT) uygulanan 85 olgu retrospektif olarak incelendi. Olgular yaş, cinsiyet, semptom, tanı ve tedaviye yanıt açısından değerlendirildi. Bulgular: O...

show abstract

Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis

Cited by 73 publications

References 24 publications

Factors Influencing Length of Hospital Stay in Patients with Bacterial Pleural Effusion

Factors Influencing Length of Hospital Stay in Patients with Bacterial Pleural Effusion

U.K. Controlled Trial of Intrapleural Streptokinase for Pleural Infection

Intrapleural Fibrinolytic Treatment: Management of 85 Cases

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