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

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.