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

Abstract

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.