Intrapleural fibrinolytic therapy for complicated pleural effusions

1998 ◽  
Vol 18 (6) ◽  
pp. 73-80 ◽  
Author(s):  
BS Monroe ◽  
D Warner
Keyword(s):  
Clinical Experience ◽  
Chest Tube ◽  
Surgical Intervention ◽  
Fibrinolytic Therapy ◽  
Pleural Space ◽  
Pleural Effusions ◽  
Fibrinolytic Agents ◽  
Tube Drainage ◽  
Major Improvement ◽  
Intrapleural Administration

Intrapleural administration of fibrinolytic agents can be used to degrade the fibrin present in complicated pleural effusions, thus decreasing viscosity of the fluid and enhancing evacuation of the pleural space via chest tube drainage. Patients who may otherwise need surgical intervention could benefit from this treatment. As more knowledge is gained through clinical experience and research studies, patients' outcomes may show major improvement.

Intrapleural Alteplase in a Patient with Complicated Pleural Effusion

2003 ◽  
Vol 37 (3) ◽  
pp. 376-379 ◽  
Author(s):  
Charlotte A Walker ◽  
Mary Beth Shirk ◽  
Marva M Tschampel ◽  
James A Visconti
Keyword(s):  
Pleural Effusion ◽  
Chest Tube ◽  
Pleural Cavity ◽  
Surgical Intervention ◽  
Chest Tube Drainage ◽  
Tube Drainage ◽  
X Ray ◽  
Case Summary ◽  
Chest X Ray ◽  
Intrapleural Administration

OBJECTIVE: To report the intrapleural use of alteplase in a patient diagnosed with complicated pleural effusion (CPE). CASE SUMMARY: A 62-year-old white woman admitted with respiratory distress and hypotension developed a right-sided multi-loculated pleural effusion. Thoracentesis and chest tube drainage were not successful in resolving the effusion. In an attempt to increase the drainage of the pleural effusion, alteplase 16 mg was administered into the pleural cavity via the chest tube on 6 consecutive days. As a result, the volume drained from the patient's chest tube increased, there was improvement on the chest X-ray, and she did not require surgical intervention. DISCUSSION: While streptokinase and urokinase have been shown to be useful adjuncts to chest tube drainage in the treatment of complicated pleural effusion and empyema, there have been no reports on the use of intrapleural alteplase. This report demonstrates that intrapleural administration of alteplase is a useful adjunct to tube drainage in resolving CPE. CONCLUSIONS: This patient's CPE resolved when intrapleural alteplase was used as an adjunct to chest tube drainage and antibiotics. Controlled trials need to be conducted to investigate fully the efficacy, dosing, and safety of intrapleural alteplase in the treatment of patients with CPE and empyema.

Chest Tube Drainage of Transudative Pleural Effusions Hastens Liberation From Mechanical Ventilation

CHEST Journal ◽  
2011 ◽  
Vol 139 (3) ◽  
pp. 519-523 ◽  
Author(s):  
Yizhak Kupfer ◽  
Chanaka Seneviratne ◽  
Kabu Chawla ◽  
Kavan Ramachandran ◽  
Sidney Tessler
Keyword(s):  
Mechanical Ventilation ◽  
Chest Tube ◽  
Chest Tube Drainage ◽  
Pleural Effusions ◽  
Tube Drainage

Management of Noncommunicating Multiloculated Pleural Space Infection With Fibrinolytic Augmented Multiple Chest Tube Drainage

2016 ◽  
Vol 23 (2) ◽  
pp. e14-e17 ◽  
Author(s):  
Abhishek Biswas ◽  
Michael A. Jantz ◽  
Matthew D. Barnes ◽  
Hiren J. Mehta
Keyword(s):  
Chest Tube ◽  
Pleural Space ◽  
Chest Tube Drainage ◽  
Tube Drainage ◽  
Space Infection

Pleural Effusions (Parapneumonic Process and Empyema)

2016 ◽  
Author(s):  
Timothy Niessen
Keyword(s):  
Surgical Intervention ◽  
Empiric Therapy ◽  
Pleural Space ◽  
Pulmonary Infections ◽  
Pleural Effusions ◽  
Antibiotic Selection ◽  
Resistance Patterns ◽  
Local Antibiotic ◽  
Infectious Organism

Pleural effusions occur when an influx of fluid into the pleural space exceeds its removal. An exudative effusion, which results from leaky barriers, is often associated with infections. Parapneumonic effusions are exudative pleural effusions adjacent to pulmonary infections. Most parapneumonic effusions are sterile and resolve with treatment of the underlying pneumonia. They may, however, evolve through the exudative, fibrinopurulent, and organizing phases of empyema formation. Empyema occurs when frank pus occupies the pleural space and requires drainage. For parapneumonic process, antibiotic selection is similar to that for pneumonia and should target the underlying infectious organism according to culture and susceptibility results. Initial empiric therapy should take into account local antibiotic policies, resistance patterns, and should include anaerobic coverage. In some cases, after antibiotics and thoracentesis are initiated, surgical intervention may be necessary. Timely drainage of complicated parapneumonic effusions or empyema is critical.

scholarly journals Pleural Effusion in Children: How often do we suspect Tubercular origin?

1970 ◽  
Vol 30 (3) ◽  
pp. 132-134
Author(s):  
PN Shrestha ◽  
A Rayamajhi
Keyword(s):  
Pleural Effusion ◽  
Chest Tube ◽  
Clinical History ◽  
Chest Tube Drainage ◽  
Pleural Effusions ◽  
Tube Drainage ◽  
Nephritic Syndrome ◽  
Study Results ◽  
Detailed Clinical History ◽  
Chest X Ray

Introduction: Pleural effusion is a common problem in children; mostly due to common causes like pyogenic or tubercular infections. Different studies have showed that about 30%-60% of pleural effusion have resulted into formation of empyema. Method: This was an observational study done in children aged 3 months to 14 years with a diagnosis of pleural effusion admitted at Kanti Children’s Hospital, Maharajgunj from August 2009 to March 2010. The aim of the study was done to find out different modalities of treatment for the same and their outcome. A detailed clinical history and physical examination, was done in all children. Chest x-ray, laboratory reports and treatment were recorded and all patients followed up until death or discharge. Any change of management was also noted. Pleural effusion caused by nephritic syndrome or congestive cardiac failure were excluded from the study. Results: During the study period of eight months, 64 patients were admitted with the diagnosis of pleural effusion. Boys to girls ratio was 2:1. Right-sided pleural effusions were more common than left sided pleural effusions (53% vs. 37%). Most of patients improved with parental antibiotics along with chest tube drainage (62%). One in three patients (31%) received anti-tubercular drugs. Three patients (4.6%) were referred to surgeon for decortications and one patient (1.6%) died. Conclusion: Though chest tube drainage with parental antibiotics was the mainstay of treatment of pleural effusion, however one-third of patients also received anti-tubercular drugs. Key words: Pleural effusion; pyogenic; decortication; adenosine deaminase (ADA). DOI: 10.3126/jnps.v30i3.3914J Nep Paedtr Soc 2010;30(3):132-134Introduction: Pleural effusion is a common problem in children; mostly due to common causes like pyogenic or tubercular infections. Different studies have showed that about 30%-60% of pleural effusion have resulted into formation of empyema. Method: This was an observational study done in children aged 3 months to 14 years with a diagnosis of pleural effusion admitted at Kanti Children’s Hospital, Maharajgunj from August 2009 to March 2010. The aim of the study was done to find out different modalities of treatment for the same and their outcome. A detailed clinical history and physical examination, was done in all children. Chest x-ray, laboratory reports and treatment were recorded and all patients followed up until death or discharge. Any change of management was also noted. Pleural effusion caused by nephritic syndrome or congestive cardiac failure were excluded from the study. Results: During the study period of eight months, 64 patients were admitted with the diagnosis of pleural effusion. Boys to girls ratio was 2:1. Right-sided pleural effusions were more common than left sided pleural effusions (53% vs. 37%). Most of patients improved with parental antibiotics along with chest tube drainage (62%). One in three patients (31%) received anti-tubercular drugs. Three patients (4.6%) were referred to surgeon for decortications and one patient (1.6%) died. Conclusion: Though chest tube drainage with parental antibiotics was the mainstay of treatment of pleural effusion, however one-third of patients also received anti- tubercular drugs. Key words: Pleural effusion, pyogenic, decortication, adenosine deaminase (ADA). DOI: 10.3126/jnps.v30i3.3914J Nep Paedtr Soc 2010;30(3):132-134

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