Study of intrapleural fibrinolytic therapy in loculated pleural collections
European Journal of Molecular & Clinical Medicine,
2023, Volume 10, Issue 3, Pages 1510-1518
Abstract
To study of intrapleural fibrinolytic therapy in loculated pleural collectionsMaterial and methods: All 50 patients of parapneumonic effusions with persistent pleural fluid and poor chest-tube drainage (less than 150ml/day) despite an appropriately positioned and patent drain; multiple loculi or fibrin strands in pleura as depicted by ultrasonography or CT scan chest were included in the study. Imaging studies with either chest radiography, ultrasonography (USG) or computed tomography (CT) were performed before the initiation of IPFT to assess the quantification of fluid the site and size of loculations and the extent of associated pleural thickening, marking of chest wall for site of insertion of chest drain.
Results: In 52% (n=26) of patients, the pleural effusion is caused by tuberculosis since these patients are primarily from rural areas and have low socioeconomic level. However, there were 10% (n=5) cases of malignant pleural effusion and 20% (n=10) cases of pneumonia with complex parapneumonic effusion. 6% of cases (n=3) involved hemothorax, while 12% involved empyema. 54% of the group under investigation needed three cycles of IPFT, followed by 46% who needed just two cycles and 10% who needed three cycles. 25 participants were found to have had a 10% improvement in FVC, while 19 patients had a 20% improvement. Only six patients saw the maximal FVC improvement of 30%. After IPFT, the FVC might reach a maximum of 70%. According to USG chest imaging, 86% of subjects had effusions resolve to residual fluid less than 50 ml.
Conclusion: Studies have demonstrated that using intrapleural fibrinolytics is a good substitute for risky surgical treatments including VATS (video-assisted thoracoscopic surgery), thoracotomy, and decortication.
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