Intrapleural Fibrinolysis in Post-tubercular Loculated Pleural Effusions at a Tertiary-Care Respiratory Center: An Uncontrolled Blinded Before-After Intervention Study
Article Type:
Research/Original Article (بدون رتبه معتبر)
Abstract:
Background
Tuberculous, parapneumonic and traumatic loculated pleural-effusions pose therapeutic challenges due to resultant pleural-thickening and compromised lung-function for life. Tuberculosis is widely prevalent in developing countries, necessitating appropriate, effective, and economical treatment for loculated pleural-effusion to reduce the burden and sequelae.
Objective
An uncontrolled and blind before-after intervention study to determine the effectiveness of intrapleural fibrinolytic therapy (IPFT) using urokinase in loculated pleural effusions was conducted at a tertiary-care respiratory center after obtaining approval and written informed consent.
Methods
Fifty-one patients with loculated pleural effusion were administered with repeated cycles of three doses of 1 Lakh IU of urokinase intrapleurally until complete drainage of pleural fluid. Pre- and post-IPFT clinical and radiological responses were compared using removal of fluid, ultrasound, and chest radiography were compared. The Kolmogorov-Smirnov test and paired t test with significance at a P value less than 0.05 were applied to test statistically significant differences in proportions and means, respectively.
Results
Tuberculosis was the most common etiology leading to loculated pleural effusion (80%), and 82.4% of tuberculosis patients required at least two cycles of IPFT. Complete resolution in chest radiograph after IPFT was observed in 80.4% of patients. Chest pain (13.7%) and fever (9.8%) were the most common undesired effects associated with IPFT. A statistically significant reduction in mean intrapleural fluid levels pre- and post-IPFT from 184±81 ml to 67±52 ml was observed.
Conclusion
IPFT with urokinase is an effective treatment modality in patients with post-tubercular loculated pleural effusions. IPFT has minimal and tolerable undesired effects and prevents sequelae such as pleural thickening and consequent compromise of respiratory function.
Language:
English
Published:
Hospital Practices and Research, Volume:3 Issue: 2, Spring 2018
Pages:
59 to 63
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