Summary
Acute pleural empyema which is not amenable to pleural puncture or closed thoracic
drainage should be treated operatively by decortication or, in persistent cavities,
by open thoracostomy drainage.
In the last 2 years we have instilled 500,000 IU of fibrinolysines (streptokinase
and streptodornase) per day into the pleural cavity of 27 patients with pleural infections
requiring closed intrapleural drainage. By means of this treatment, pus and fibrinous
membranes are liquefied and necrotic tissue is discharged. Therapeutic success is
indicated by considerably increased fluid drainage about one hour after instillation.
This therapy was performed for an average of 5 days. In 12 patients (44%) pleural
empyema could be cured. In the other 15 cases decortication, and in 3 of them open
thoracostomy drainage, was necessary.
In our opinion intrapleural instillation of fibrinolytic enzymes should be added to
the well-recognized methods of treatment of pleural empyema, although not replace
them.
Key words
Enzymatic debridement of empyema - Fibrinolytic enzymes - Pleural empyema
