Minimally invasive treatment of complicated parapneumonic effusions and empyemas in adults.

OBJECTIVES: To summarize the evidence underlying the non-surgical management of patients with complicated parapneumonic effusions (CPPE) or empyemas.

DATA SOURCE: All articles published in PubMed according to their relevance with the subject were identified.

RESULTS AND CONCLUSIONS: There is a lack of powered randomized controlled studies comparing medical and surgical approaches to CPPE/empyemas in adults. In addition to antibiotics for an unspecified period of time, CPPE/empyemas can initially be treated with a therapeutic thoracentesis (which can be repeated if necessary), the insertion of a small-bore chest catheter under ultrasound guidance, or the administration through the catheter of fibrinolytics alone, saline alone or fibrinolytics in combination with either saline or deoxyribonuclease. These conservative measures resolve more than 90% of the cases, thus making a rescue surgery unnecessary.