Treatment of complicated parapneumonic pleural effusion and pleural parapneumonic empyema

Abstract

SummaryBackgroundWe performed this observational prospective study to evaluate the results of the application of a diagnostic and therapeutic algorithm for complicated parapneumonic pleural effusion (CPPE) and pleural parapneumonic empyema (PPE).Material/MethodsFrom 2001 to 2007, 210 patients with CPPE and PPE were confirmed through thoracocentesis and treated with pleural drainage tubes (PD), fibrinolytic treatment or surgical intervention (videothoracoscopy and posterolateral thoracotomy). Patients were divided into 3 groups: I (PD); II (PD and fibrinolytic treatment); IIIa (surgery after PD and fibrinolysis), and IIIb (direct surgery). The statistical study was done by variance analysis (ANOVA), χ 2 and Fisher exact test.ResultsThe presence of alcohol or drug consumption, smoking and chronic obstructive pulmonary disease (COPD) were strongly associated with a great necessity for surgical treatment. The IIIa group was associated with increased drainage time, length of stay and complications. No mortality was observed. The selective use of PD and intrapleural fibrinolysis makes surgery unnecessary in more than 75% of cases.ConclusionsThe selective use of PD and fibrinolysis avoids surgery in more than 75% of cases. However, patients who require surgery have more complications, longer hospital stay, and more days on PD and they are more likely to require admittance to the Intensive Care Unit.

First case of pneumonia-parapneumonic effusion due to Trichoderma longibrachiatum

“…A parapneumonic effusion is a pleural effusion that results from a lung infection such as pneumonia or lung abscess. It is divided to three types: uncomplicated effusion, complicated effusion, and empyema [ 6 ]. Uncomplicated effusion usually responds well to appropriate treatment with antibiotics.…”

Discrimination of Exudative Pleural Effusions Based on Pleural Adenosine Deaminase (ADA)-C-Reactive Protein (CRP) Levels, and Their Combination: An Observational Prospective Study

“…The pleural effusion was considered parapneumonic when it was associated with pulmonary infiltrates responsive to antibiotic treatment, fever, purulent sputum or when a microorganism was identified in the pleural fluid. Among parapneumonic effusions, CPPE (complicated parapneumonic pleural effusions) were certified when pleural fluid was obviously pus(empyema),and when pH was lower than 7.2 and/or glucose was lower than 40mg/dl [ 16 ]. TPE was diagnosed based on positive pleural fluid or pleura tissue cultures for mycobacterium tuberculosis or when pleural effusion was co-existing with positive cultures for mycobacterium tuberculosis in samples by other sites or when the pleural biopsy specimen revealed typical epithelioid cell.…”

“…The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Ethics Committee of University Hospital of Larissa (Ethical Committee Approval Number: 45/02- [12][13][14][15][16][17][18][19].…”