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Intrapleural Streptokinase for Empyema and Complicated Parapneumonic Effusions
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Intrapleural Streptokinase for Empyema and Complicated Parapneumonic Effusions
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Journal Article
Intrapleural Streptokinase for Empyema and Complicated Parapneumonic Effusions
2004
Overview
Abstract
We conducted a single-center, randomized, placebo-controlled trial to determine whether streptokinase instillations adjunctive to chest tube drainage reduce the need for surgery and improve outcome in patients with pleural empyema. Fifty-three patients (frank pus aspirated, 81%; microbiological agent cultured, 62%; mean effusion pH, 6.6 ± 0.4) received antibiotic treatment, chest tube drainage, and once-daily pleural rinses with either normal saline or normal saline with streptokinase (250,000 IU). Nine patients were excluded for various reasons before pleural rinses were started. Streptokinase (n = 22) was instilled over 4.5 ± 2 days and saline (n = 22) was instilled over 3 ± 1.3 days. One patient in each group died during treatment. Clinical treatment success and need for referral to surgery were the main outcome measures. No difference was observed after 3 days. After 7 days, streptokinase-treated patients had a higher clinical success rate (82 vs. 48%, p = 0.01) and fewer referrals for surgery (45 vs. 9%, p = 0.02). No significant radiologic or functional differences were observed between groups during follow-up over 6 months. We conclude that intrapleural streptokinase adjunctive to chest tube drainage reduces the need for surgery and improves the clinical treatment success in patients with pleural empyema.
Publisher
Am Thoracic Soc,Oxford University Press,American Lung Association
Subject
/ Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
/ Biological and medical sciences
/ Drainage
/ Empyema, Pleural - drug therapy
/ Female
/ Fibrinolytic Agents - administration & dosage
/ Humans
/ Male
/ Pleural Effusion - drug therapy
/ Sodium Chloride - administration & dosage
/ Streptokinase - administration & dosage
/ Success
/ Surgery
