INTRAPLEURAL FIBRINOLYTICS IN MANAGEMENT OF EMPYEMA-THORACIS

Study objective: To determine the success and complication rates of fi brinolytic therapy (FL) in the treatment of thoracic empyema. Design a nd patients: Between December 1992 and November 1994, all patients ref erred with empyema thoracis (ET) were offered FL. FL consisted of stre ptokinase (275,000+/-170,000 IU) or urokinase (121,000+/-57,000 IU) da ily for a mean of 6.2+/-2.1 days. Setting: The University of New Mexic o Health Sciences Center and the Albuquerque Veterans Affairs Medical Center. Results: Twenty-six patients were treated, Sixty-two percent ( 16/26) had complete resolution (CR) of symptoms, near or complete norm alization of chest radiographic findings, and required no surgery or e mpyema tubes. Eight percent (2/26) had relief of symptoms and partial resolution (PR) of radiographic abnormalities and were discharged from the hospital with empyema tubes in place, All patients with PR had em pyema tubes removed within 30 days of hospital discharge, Thirty-one p ercent (8/26) of patients failed to completely improve clinically or r adiographically (nonresponse) and were treated with decortication or e mpyema tubes for greater than 30 days, Bleeding occurred in a single p atient (4%), There was no mortality associated with FL use. Conclusion s: The use of FL is associated with resolution of ET in 69% (18/26) of patients, This modality is safe, effective, and spares most patients with empyema the morbidity and mortality of thoracotomy.