Surgical treatment for parapneumonic pleural effusion in adults

Abstract

At least, 40% of all patients with pneumonia will have a parapneumonic pleural effusion (PPE), which is associated to considerable morbidity and mortality. The PPE has three phases: exsudative, fibrinopurulent and organizing, which represent the development of the disease. Despite the great number of therapeutic methods, the PPE management is not well established, because for each phase the success rate of each technique is variable. The objective of this review of literature was to analyze each method available and its indications. Briefly, the use of therapeutic thoracocentesis is restricted to small simple PPE, which are limited to half of the hemithorax. On the other hand, tube thoracostomy has a wider indication: large simple effusions and free-flowing complicated PPE or empyema. For multiloculated cases, the Video-assisted Thoracoscopic Surgery (VATS) is recommendable. Finally, the decortication through thoracotomy is indicated for chronic cases with lung entrapment, although there are evidences that VATS can be used too and, if needed, converted to thoracotomy in the operation room. Regarding thrombolytics, the data available about its efficacy is controversial, thereby its use is still very restricted