Abstract
Background: Thoracic empyema (TE) and loculated parapneumonic effusions (CPE) cause considerable morbidity and mortality. Intrapleural Tenectaplase (TNKase) has been recently employed to lyse the fibrinous structures of multiloculated pleural space with reduction of surgical intervention. This study was done to determine the safety and efficacy of TNKase for the treatment of loculated parapneumonic pleural effusions and thoracic empyema
Patients and Methods: This study was done at Respirology Department, Farwaniya Hospital, M.O.H,Kuwait, between January 2012 and November 2013. 58 patients were admitted with loculated pleural effusions {22 patients (37.9%) with thoracic empyema and 36 patients (62.1%) with complicated parapneumoic effusion. All patients received intrapleural TNKase after failure of complete drainage of pigtail catheter, which was inserted under chest ultrasound guidance. The evaluation was made according to imaging, laboratory, and clinical status. Adverse effects and hemorrhagic complications were also reported.
Results: The overall intrapleural TNKase effectiveness in achieving complete drainage of pleural collections was 49 of 58 cases (84.5%). Intrapleural TNKase was successful in 70% (14 of 20) of patients with TE, and 92.1% (35 of 38) of patients with CPE. The total number of TNKase instillations ranged from 2 to 5 (mean, 3.2). The mean volume of pleural fluid increased significantly after TNKase administration (p< 0.001). Complications observed were mild and local bleeding occurred in only 4 patients (6.9%).
Conclusion: Intrapleural TNKase is an effective therapy in improving drainage of loculated CPE and TE and can prevent surgical interventions.
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