LAUSR

The optimal management of complicated parapneumonic effusions and empyemas remains undefined. Over the past two decades, three guidelines from scientific societies have been developed to aid treatment selection in this setting [1–3]. In 2000, the American College of Chest Physicians stated that intrapleural fibrinolytics, video-assisted thoracoscopic surgery (VATS) and surgery (thoracotomy with or without decortication) were all acceptable approaches for managing patients who meet any of the following characteristics [1]: pus (category 4 effusions or, strictly speaking, empyemas), large (at least half of the hemithorax) or loculated effusions, positive pleural fluid cultures or Gram stains, or a fluid pH <7.20 (the last three conditions integrating category 3 effusions). Intrapleural tPA/DNase therapy is cost-effective for the management of complicated parapneumonic effusions and empyemas http://bit.ly/2Lv0Kg9