Treatment
Table 7. Factors Associated with Outcomes and Indication for Drainage of Parapneumonic Effusions
Size of Effusion Small
< 10 mm on lateral decubitus radiograph or opacifies < ¼ of the hemithorax
Moderate
> 10 mm rim of fluid but opacifies < ½ of the hemithorax
1) Bacterial culture and/or Gram stain results negative
OR
2) Bacterial culture and/or Gram stain results positive (empyema)
Low to moderate
1) No, if the patient has no respiratory compromise and the pleural fluid is not consistent with empyema (sampling of pleural fluid by simple thoracentesis may help determine the presence or absence of empyema and the need for a drainage procedure, while sampling with a drainage catheter may provide both diagnostic and therapeutic benefit)
2) Yes, if the patient has respiratory compromise or if the pleural fluid is consistent with empyema
Large
Opacifies > ½ of the hemithorax
Bacterial culture and/or Gram stain results positive (empyema)
High Yes in most cases Bacteriology
Bacterial culture and Gram stain results unknown or negative
Risk of Poor Outcome
Low
Tube Drainage With or Without Fibrinolysis or VATS
No; sampling of pleural fluid is not routinely required
20
