PT  - JOURNAL ARTICLE
AU  - TK Lim
AU  - NK Chin
TI  - Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis
AID  - 10.1183/09031936.99.13351499
DP  - 1999 Mar 01
TA  - European Respiratory Journal
PG  - 514--518
VI  - 13
IP  - 3
4099  - http://erj.ersjournals.com/content/13/3/514.short
4100  - http://erj.ersjournals.com/content/13/3/514.full
SO  - Eur Respir J1999 Mar 01; 13
AB  - The efficacy of three different treatment protocols was compared: 1) simple chest tube drainage (Drain); 2) adjunctive intrapleural streptokinase (IP-SK); and 3) an aggressive empirical approach incorporating SK and early surgical drainage (SK+early OP) in patients with pleural empyema and high-risk parapneumonic effusions. This was a nonrandomized, prospective, controlled time series study of 82 consecutive patients with community-acquired empyema (n=68) and high-risk parapneumonic effusions (n=14). The following three treatment protocols were administered in sequence over 6 years: 1) Drain (n=29, chest catheter drainage); 2) IP-SK (n=23, adjunctive intrapleural fibrinolysis with 250,000 U x day(-1) SK); and 3) SK+early OP (n=30, early surgical drainage was offered to patients who failed to respond promptly following initial drainage plus SK). The average duration of hospital stay in the SK+early OP group was significantly shorter than in the Drain and IP-SK groups. The mortality rate was also significantly lower in the SK+early OP than the Drain groups (3 versus 24%). It was concluded that an empirical treatment strategy which combines adjunctive intrapleural fibrinolysis with early surgical intervention results in shorter hospital stays and may reduce mortality in patients with pleural sepsis.