Journal - Chest

Abstract :

To test the efficacy of intrapleural fibrinolytic therapy inpatients with loculated pleural effusions, we conducted an open,prospective, and multicenter trial among five hospitals in Mexico.We enrolled patients with hemothorax or empyema, clotted and/orloculated, that was not resolved through conventional pleuraldrainage with chest tube and antibiotics in patients with empyema.All patients received repeated doses of 250,000 IU of streptokinasethrough chest tube. Effectiveness criteria were before and afterintrapleural streptokinase (IPSK) drainage, and poststreptokinaseradiographic and respiratory function test improvement. Forty-eightpatients were studied; there were 30 patients with empyemas,14 with hemothorax, and 4 patients with malignant pleural effusionswithout lung trapping. Successful fibrinolysis was obtainedin 44 patients, with complete resolution of the pleural collectionand adequate radiologic and spirometric improvement. In threeof four patients with multiloculated malignant hemothorax withhigh-yielding pleural drainage, IPSK allowed successful lysisof loci and an adequate pleurodesis was achieved. Only fourpatients required surgical treatment. The overall success ratein our series was 92%, similar to previous reports. The resultsin this first prospective and multicentric trial suggest thatintrapleural fibrinolysis is an effective and safe adjunctivetreatment in patients with heterogeneous pleural coagulatedand loculated collections to restore the pulmonary functionassessed by respiratory function tests and can obviate surgeryin most cases.