Tk. Lim et Nk. Chin, Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis, EUR RESP J, 13(3), 1999, pp. 514-518
The efficacy of three different treatment protocols was compared: 1) simple
chest tube drainage (Drain); 2) adjunctive intrapleural streptokinase CIP-
SK); and 3) an aggressive empirical approach incorporating SK and early sur
gical drainage (SK+early OF) in patients with pleural empyema and high-risk
parapneumonic effusions,
This was a nonrandomized, prospective, controlled time series study of 82 c
onsecutive patients with community-acquired empyema (n=68) and high-risk pa
rapneumonic effusions (n=14). The following three treatment protocols were
administered in sequence over 6 years: 1) Drain (n=29, chest catheter drain
age); 2) IP-SK (n=23, adjunctive intrapleural fihrinolysis with 250,000 U.d
ay(-1) SK); and 3) SK+early OP (n=30, early surgical drainage was offered t
o patients who failed to respond promptly following initial drainage plus S
K),
The average duration of hospital stay in the SK+early OP group was signific
antly shorter than in the Drain and IP-SK groups. The mortality rate was al
so significantly lower in the SK+early OP than the Drain groups (3 versus 2
4%).
It was concluded that an empirical treatment strategy which combines adjunc
tive intrapleural fibrinolysis with early surgical intervention results in
shorter hospitalstays and may reduce mortality in patients with pleural sep
sis.