Use of fibrinolytic agents in the management of complicated parapneumonic effusions and empyemas

Recent advances in the management of pleural sepsis: what is the evidence?

The management of pleural sepsis involves early diagnosis, administration of appropriate antibiotics, recognition of poor prognostic features and timely intervention to drain the infected pleural space. Important recent advances in the management of pleural sepsis include better imaging techniques, the use of flexible image-guided drainage catheters, adjunctive intrapleural thrombolytic therapy and the introduction of interventional thoracoscopy. These advances have been augmented, in the past year, by results from prospective controlled studies comparing different therapeutic options. This review describes an evidence-based approach to the management of pleural sepsis which incorporates recent therapeutic advances.