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[Drug treatment with fibrinolytics (corrected) of secondary empyema secondary to complicated parapneumonic effusion]
E Valdés Diéguez1, V Modesto Alapont, C Gutiérrez San Román
1Servicio de Cirugía Pediátrica, Hospital Universitario Infantil La Fe, Valencia. estibalizvaldes@hotmail.com
Abstract:
In recent years we have observed in our country an increase in complications associated with bacterial pneumonia, such as pleural effusion and empyema. The initial treatment is an association of antibiotics, covering the potential germ involved, and the placement of a pleural drainage tube, in order to accelerate the resolution process. Formation of septa within the pleural cavity requires additional therapy (antifibrinolytic treatment, videothorascopy), but no one of these two alternatives is been demonstrated better than the other. We present a review that covers last 15 years (1990-2006), related to management of empyema. The management strategy with initial instillation of antifibrinolytic intrapleural makes our series the longest in our country using such treatment (30 of 50 patients reviewed (60) were treated with this technique). Initial success was 96% with this modality, without rescuing surgery. There is also a descriptive analysis of several clinical, laboratory and radiological parameters. In comparative analysis, length of stay in intensive care unit decreases in those patients treated with antifibrinolytics. This result is a prove of the efficacy of this treatment, and quite encourageing.
Insights
Antifibrinolytic treatment for bacterial pneumonia complications like empyema shows high success rates. This approach, involving intrapleural instillation, reduces intensive care unit stays, proving its efficacy in managing pleural infections.
Area of Science:
- Pulmonology
- Infectious Diseases
Context:
- Rising incidence of bacterial pneumonia complications, including pleural effusion and empyema.
- Standard initial treatment involves antibiotics and pleural drainage, with further interventions for septated empyema.
- Limited evidence comparing antifibrinolytic therapy and video-assisted thoracoscopy for complex empyema.
Purpose:
- To review the management strategies for empyema over a 15-year period (1990-2006).
- To evaluate the efficacy of initial intrapleural antifibrinolytic instillation in managing empyema.
- To analyze clinical, laboratory, and radiological parameters associated with empyema management.
Summary:
- A review of 50 empyema cases, with 60% treated using initial intrapleural antifibrinolytic instillation.
- Achieved a 96% initial success rate with antifibrinolytic therapy, avoiding the need for rescue surgery.
- Descriptive analysis of patient parameters and comparative analysis of treatment outcomes.
Impact:
- Demonstrates the high efficacy of intrapleural antifibrinolytic treatment in empyema management.
- Significant reduction in intensive care unit length of stay for patients treated with antifibrinolytics.
- Provides encouraging evidence for the use of antifibrinolytic therapy as a primary treatment modality for empyema.
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