Intrapleural fibrinolytic therapy for acute empyema in elderly patients with high surgical risk

概要

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Intrapleural fibrinolytic therapy has been considered to be effective in the treatment of fibrinopurulent empyema. However, its efficacy in elderly patients with a high surgical risk has not yet been fully defined. Between 2008 and 2012, 8 elderly patients with performance status (PS) 2 or 3 were treated with the intracavitary instillation of urokinase because of ineffective chest drainage. The mean age was 76 years old, and 7 men and 1 woman were included. Six patients had mental disorders. The etiology of empyema was aspiration pneumonia in 5 patients, community-acquired pneumonia in 2 patients, and an aspirated foreign body in 1 patient. One patient was cured by intrapleural fibrinolytic therapy, and all the other 7 patients who failed to respond to that therapy were cured by subsequent surgical treatment; 4 patients were treated with surgery and 3 patients were treated with percutaneous abscess drainage. Acute empyema in elderly patients with PS 2 or 3 is most often associated with mis-swallowing. We concluded that insufficient evidence exists to support intrapleural fibrinolytic therapy for those patients.