Abstract
Objective
To determine the usefulness and the results of a strategy using intrapleural streptokinase (SK) instillation guided by repeated computed tomography (CT) scan examinations in pleural empyemas unresponsive to chest tube drainage.
Design
A retrospective chart review.
Setting
The medical Intensive Care Unit and Department of Radiology, in a university hospital.
Patients
Sixteen patients with empyema who had a persistent pleural effusion despite drainage, among 37 patients with infectious pleural effusion.
Interventions
In the 16 patients, CT examination was performed before and at least once after SK. Intrapleural SK was instilled, either through the chest tube or via a needle puncture, according to the CT scan, results.
Results
The first CT scan confirmed a persistent effusion in all, showing a multiloculated effusion in 13 patients, and an ectopic loculus in one. The first SK instillation resulted in a dramatic increase of fluid drained per day (from 68±28 ml to 567±262 ml;p<0.001), leading to complete resolution in 11 patients, while the others required a second CT scanguided procedure. In one, the chest tube was misplaced, while in two, transparietal injection was needed. Finally, a complete resolution was observed in 14 (87.5%) of the patients. Two patients had a poor initial response to SK and were eventually scheduled for video-thoracoscopy. A single episode of chills and fever was observed among 32 SK instillations.
Conclusion
CT-guided SK instillation in pleural empyema appears to be safe, and allowed complete resolution in 87.5% of our patients.
Similar content being viewed by others
References
Van Way C, Narrod J, Hopeman A (1988) The role of early limited thoracotomy in the treatment of empyemas. J Thorac Cardiovasc Surg 96:436–439
Sahn S (1993) Management of complicated parapneumonic effusions. Am Rev Respir Dis 148:813–817
Landreneau R, Keenan R, Hazelrigg S, Mack M, Naunheim K (1995) Thoracoscopy for empyema and hemothorax. Chest 109:18–24
Robinson L, Moulton A, Fleming W, Alonso A, Galbraith T (1994) Intrapleural fibrinolytic treatment of multiloculated thoracic empyemas. Ann Thorac Surg 57:803–814
Moulton J, Benkert R, Weisiger K, Chambers J (1995) Treatment of complicated pleural fluid collections with image-guided drainage and intracavitary urokinase. Chest 108:1252–1259
Bouros D, Schiza S, Panagou P, Drositis J, Siafakas N (1994) Role of streptokinase in the treatment of acute loculated parapneumonic pleural effusions and empyema. Thorax 49:852–855
Lee K, Im J, Kim Y, Hwang S, Bae W, Lee B (1991) Treatment of thoracic multiloculated empyemas with intracavitary urokinase: a prospective study. Radiology 179:771–775
Taylor R, Rubens M, Pearson M, Barnes N (1994) Intrapleural streptokinase in the management of empyema. Thorax 49:856–859
Bressler E, Francis I, Glazer G, Gross B (1987) Bolus contrast medium enhancement for distinguishing pleural from parenchymal lung disease: CT features. J Comput Assist Tomogr 11:436–440
Light R (1995) A new classification of parapneumonic effusions and empyema. Chest 108:299–301
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Roupie, E., Bouabdallah, K., Delclaux, C. et al. Intrapleural administration of streptokinase in complicated purulent pleural effusion: A CT-guided strategy. Intensive Care Med 22, 1351–1353 (1996). https://doi.org/10.1007/BF01709550
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01709550