In this article, we will discuss the Use of Intrapleural Thrombolytic Agents in the Management of Acute Empyema Thoracis. So, let’s get started.
Intrapleural Thrombolytic Agents
These agents have a role to break the loculations in multiloculated empyema. Intrapleural instillation of a fibrinolytic agent, i.e. streptokinase (usual dose is 250,000 U in 100 ml saline) or urokinase (100,000 U diluted in 100 ml of saline) or tissue plasminogen activator mg through a chest tube is helpful if drainage stops because of loculations and opacities on chest X-ray persist. After each instillation, the chest tube is clamped for 2 hours to allow the thrombolytic agents to attack the fibrin membranes responsible for loculations. Thrombolytic agents can be daily instilled for up to 14 days. This is a costly treatment. The intrapleural injection of thrombolytic agents does not affect the systemic coagulation system as these do not diffuse through the pleura.
Contraindications of Thrombolytic Therapy
- Presence of bronchopleural fistula
- Recent trauma
- Recent bronchial suturing