Bouros, S Schiza, et al (Univ of Crete, Greece; Univ Gen Hosp, Heraklion, Crete, Greece)
Intrapleural Urokinase Versus Normal Saline in the Treatment of Complicated Parapneumonic Effusions and Empyema: A Randomized, Double-blind Study.
Am J Respir Crit Care Med 159: 37-42, 1999.
Complicated parapneumonic effusions require drainage of the pleural space to resolve fever and sepsis and for preventing the evolution of pleural emphysema. Medical treatment may produce less morbidity than any surgical intervention. Streptokinase and urokinase have been implemented for treatment of lysis of pleural fibrinous adhesions. However, whether they are effective through the lysis of pleural adhesion and not through the volume effect has not been determined.
This particular study of 31 patients with multiloculated pleural effusions has been done so as to study this effect. The parameters studied was the quantification of fluid drainage, chest radiography, pleural ultrasonography and CT scan.
This randomized study demonstrates that the effectiveness of intrapleural urokinase in the treatment of complicated parapneumonic effusions and emphyema is not primarily from the volume effect of the administered solution, but rather from the lytic action of these lesions due to urokinase. However in both the groups of patients studied the admission, duration is significantly prolonged and it really is a worth giving a thought whether an early surgical intervention especially with the help of video-assisted thoracoscopic surgery or thoractotomy is better than administrating the thrombolytic therapy.