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Update on the Role of Intrapieurai Fibrinolytic Therapy in the Management of Complicated Parapneumonic Effusions and Empyema

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A parapneumonic effusion is the collection of exudative fiuid in thepleural space associated with a concurrent pulmonary infection. Parapneumonic effusions account for approximately one-third of all effusions, and about 40% ofpatients with pneumonia develop a concomitant ejfitsion. Patients with pneumonia who develop an effusion have an increased risk of morbidity and mortality. Some of the excess mortality is due to mismanagement of the parapneumonic ejfitsion. Bacterial and white cell metabolism can rapidly turn a simple exudative parapneumonic effusion into a multiloculated purulent empyema with low pH and high lactate dehydrogenase levels. The optimal approach to treating parapneumonic effusions andpleural empyemas remains controversial. Accepted management consists of systemic antibiotics and drainage of the pleural cavity, which is achieved by either medical chest tube drainage or surgery. Several investigators have studied the efficacy and safety of intrapleural fibrinolytics in the treatment ofpleural effusion and empyema. Intrapleural instillation offibriholytic agents is undertaken to dissolve fibrinous clots and membranes, to prevent fiuid sequestration, and hence to improve drainage. Recombinant deoxyribonuclease has been reported to improve drainage in a single patient who did not respond to fibrinolytic therapy.
Key words: parapneumonic effusions, empyema, intrapleuralfibrinolytics, recombinant deoxyribonuclease.

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Informasi Detail

Judul Seri

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No. Panggil

Acta Medica Indonesiana: The Indonesian Journal of

Penerbit

Jakarta : FK universitas indonesia., 2012

Deskripsi Fisik

7p

Bahasa

ISBN/ISSN

0125-9326

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Tipe Isi

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Tipe Media

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Tipe Pembawa

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Edisi

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Pernyataan Tanggungjawab

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