Evaluation and management of pleural sepsis - 19/10/21
, Ehab Billatos a, Frank Schembri a, bAbstract |
Pleural sepsis stems from an infection within the pleural space typically from an underlying bacterial pneumonia leading to development of a parapneumonic effusion. This effusion is traditionally divided into uncomplicated, complicated, and empyema. Poor clinical outcomes and increased mortality can be associated with the development of parapneumonic effusions, reinforcing the importance of early recognition and diagnosis. Management necessitates a multimodal therapeutic strategy consisting of antimicrobials, catheter/tube thoracostomy, and at times, video-assisted thoracoscopic surgery.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Pleural sepsis that stems from an infection within the pleural space requires early recognition, evaluation, and diagnosis to determine a multidisciplinary, multimodal treatment strategy encompassing antimicrobials, catheter/tube thoracostomy, and at times, surgical intervention. |
• | Key in the diagnosis and classification of parapneumonic pleural effusions comprise of imaging to characterize the fluid volume and its internal organization as well as pleural fluid chemistry, most important of which is pleural fluid pH that may vary depending on the method of measurement. |
• | While use of intrapleural tissue plasminogen activator and deoxyribonuclease has led to improved outcomes in pleural infections, instances in which intrapleural saline irrigation may be useful include instances of bronchopleural fistula formation, significant bleeding, and/or as salvage therapy. |
• | In the case of suspected therapeutic failure, the patient should be imaged on computed tomography to evaluate for malpositioning and dislodgment of thoracostomy catheter/tube and to identify other walled-off loculated pockets in addition to reevaluating whether the current antimicrobial therapy is sufficient. |
• | Early involvement by thoracic surgery is critical in management as approximately 30% of patients encounter treatment failure and require surgical intervention and delayed referral is a risk factor for the need for open thoracotomy. |
Keywords : Pleural effusions, Empyema, Pleural disease, Sepsis, Sepsis syndrome
Plan
Vol 187
Article 106553- octobre 2021 Retour au numéro
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