Management of complicated parapneumonic effusions and thoracic empyema
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Updated: Sep 30, 2026

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
1Intensive Care Unit, Gosford Hospital, New South Wales, Australia. rcameron@doh.health.nsw.gov.au
Abstract:
The optimal management of loculated parapneumonic effusions and empyema includes breakdown of adhesions to effect drainage of infected pleural fluid. The use of fibrinolytics intrapleurally appears to enhance intercostal tube drainage, reducing the requirement for subsequent surgical mechanical debridement. This article discusses the evidence for intrapleural fibrinolytics, their good safety profile and the practicalities of dose and administration. It also reviews early surgical intervention, which may be indicated for medical treatment failure and, some would argue, as a suitable alternative to other medical interventions.
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