Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema

Cameron, Robert; Davies, Huw Richard H R

doi:10.1002/14651858.cd002312.pub3

Cited by 131 publications

(106 citation statements)

References 49 publications

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“…Because 40% of the patients required repeated aspiration, therapeutic strategies to prevent recurrent collection (and probably to preserve the peritoneal membrane) would be an interesting area for further research. For example, intrapleural fibrinolytic therapy confers significant benef it in reducing the requirement for surgical intervention in patients with complicated parapneumonic effusion or overt empyema (18). It remains to be seen if a similar approach would work for abdominal collection after peritonitis.…”

Section: Discussionmentioning

confidence: 99%

Persistent Symptomatic Intra-Abdominal Collection after Catheter Removal for Pd-Related Peritonitis

et al. 2011

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♦ ♦ ♦ ♦ ♦ Background: Peritoneal dialysis (PD) patients with severe peritonitis require catheter removal. It is often assumed that this approach, together with antibiotics, would eradicate the infection; however, some patients continue to have problems despite catheter removal. ♦ ♦ ♦ ♦ ♦ Method: We reviewed 30 consecutive PD patients in our center from 1997 to 2008 with recurrent loculated peritoneal collection after catheter removal for severe peritonitis. ♦ ♦ ♦ ♦ ♦ Results: Of the 1928 episodes of peritonitis that occurred in 702 patients during the study period, 11.1% required catheter removal and 1.6% developed recurrent peritoneal collection that required percutaneous drainage. Median time to diagnosis of intra-abdominal collection was 12 days after catheter removal (interquartile range 7 -61 days). In 25 patients (83.3%), aspirate of the abdominal collection was culture negative. In 17 patients (56.7%), the abdominal collection was recurrent and required repeated percutaneous aspiration. Only 3 patients had successful reinsertion of the peritoneal catheter but all had reduced small solute clearance after returning to PD. ♦ ♦ ♦ ♦ ♦ Conclusion: A small but not negligible proportion of patients with PD-related peritonitis develop recurrent intraabdominal collection that requires percutaneous drainage after catheter removal. The chance of a successful return to PD is very low in this group of patients. Direct conversion to long-term hemodialysis may avoid unnecessary attempts at peritoneal catheter reinsertion.

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Section: Discussionmentioning

confidence: 99%

Persistent Symptomatic Intra-Abdominal Collection after Catheter Removal for Pd-Related Peritonitis

et al. 2011

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“…A series studies also considered that the streptokinase or urokinase used in the pleural cavity can reduce hospital stay, prognosis improvement (9,(47)(48)(49)(50)(51) and prevent catastrophic hazards (4,50,52,53). However, the largest random and controlled clinical study considers that streptokinase application in the pleural cavity has failed to improve hospital stay, death rate and others, to date (22) and a researcher also considers that the fibrinolytic agent has failed to reduce fatality rate (54). At present, the application of a fibrinolytic agent has been in dispute in complicated parapneumonic effusion (55).…”

Section: Intrapleural Cavity Injectionmentioning

confidence: 99%

Infectious pleural effusion status and treatment progress

Yang

Zhang

2017

J. Thorac. Dis.

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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.

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“…Fibrinolysis was realized without deoxyribonuclease (not available in our hospital) and did not reduce the need for surgery, in our series. However, it was associated with a lower mortality rate, such as in sub-groups of proven loculated/septated effusions in a systematic review [25]. This review showed a significant reduction in surgical intervention.…”

Section: Microbiology Antibiotics and Prognosismentioning

confidence: 76%

Resistance to Co-Amoxiclav (Augmentin) in Community-Acquired and Nosocomial Pleural Infections

Annonay¹

2015

J Pulm Respir Med

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Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema

Cited by 131 publications

References 49 publications

Persistent Symptomatic Intra-Abdominal Collection after Catheter Removal for Pd-Related Peritonitis

Persistent Symptomatic Intra-Abdominal Collection after Catheter Removal for Pd-Related Peritonitis

Infectious pleural effusion status and treatment progress

Resistance to Co-Amoxiclav (Augmentin) in Community-Acquired and Nosocomial Pleural Infections

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