INTRAPLEURAL FIBRINOLYTIC THERAPY VERSUS PLACEBO IN THE TREATMENT OF ADULT PARAPNEUMONIC EFFUSIONS

Background: Parapneumonic effusion is a type of pleural effusion that arises as a result of a pneumonia. It can occur in 57% of pneumonia cases in adults. Current guidelines recommend that if chest tube drainage is ineffective, then surgical procedures should be first line management. Morbidity and mortality rate of surgical intervention are on concern. Less invasive therapies still need to be considerable clinical utility. Intrapleural Fibrinolytic agents have been used safely and effectively for complicated parapneumonic effusion but its role in parapneumonic effusion is still unknown.
Method: Literature search was performed on the PubMed, Cochrane Library, Proquest, Scopus, and EBSCO Host. Inclusion criteria of this literature searching was meta analysis, systematic review, and randomized control trial articles, articles in English or Indonesian, adult with parapneumonic effusions, and compare of fibrinolytic agents with placebo. The exclusion criteria was animal and in vitro research. Critical appraisal was assessed using FAITH tool.
Result: Three meta analysis included in this study. All of the studies concluded that there is no evidence intrapleural fibrinolytic therapy better than placebo to prevent mortality in adult with parapneumonic effusions. Even though, it is associated with reduction in surgical intervention and overall treatment failure.
Conclusion: Fibrinolytic therapy is potentially benefi cial in the management of parapneumonic effusions in the adult population. Although there is insuffi cient evidence to support the routine use of this therapy for all parapneumonic effusions. Fibrinolytic therapy may be considered in patients with loculated pleural effusions, because it may prevent the need for surgical intervention.
Keywords: Parapneumonic effusion, Intrapleural fibrinolytic, mortality