Abstrait

Current medical management of pleural infection

Demosthenes Bouros, Argyris Tzouvelekis and Katerina M Antoniou

Pulmonary infections with secondary pleural involvement have led to considerable morbidity and mortality. Their diagnosis, prognosis and medical management are challenging. The spectrum of parapneumonic pleural effusions ranges from a small pleural effusion that does not require specific therapy to multiloculated pleural empyema with pleural fibrosis, trapped lung, systemic sepsis and respiratory failure. Today’s chest physician plays a pivotal role in the timely and modern medical management of patients with parapneumonic pleural effusions and pleural empyema. However, uncertainties remain regarding the medical treatment of pleural infection which involves prolonged courses of antibiotics, attention to the patient’s nutritional state, intercostal drainage and intrapleural instillation of fibrinolytic agents. The latter is undertaken to dissolve fibrinous clots and membranes, to prevent fluid sequestration and hence to improve drainage. Our primary aim is to review the current status of knowledge regarding medical management of parapneumonic pleural effusions and pleural empyema, discuss factors which influence their clinical course and prognosis and present a number of the future perspectives.