Self-Study Resources-Bedawi ERS.ESTS statement on the management of pleural infection in adults Eur Respir J 2023

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The European Respiratory Society (ERS) and European Society of Thoracic Surgeons (ESTS) have released a comprehensive statement on the management of pleural infection in adults. The statement, produced through a multidisciplinary collaboration, reviews scientific literature across six key areas: epidemiology, antibiotic strategy, diagnostic parameters for chest tube drainage, intrapleural therapies, the role of surgery, and outcome prediction.<br /><br />Current data shows a global increase in the incidence of pleural infection, particularly among the elderly and those with chronic comorbidities. The management of pleural infections, characterized by an upward trend, includes utilizing small-bore chest tubes, optimal antibiotic coverage, and timely interventions to prevent poor outcomes.<br /><br />Initial management focuses on prompt antibiotic therapy due to the poor yield of pleural fluid cultures. Studies have highlighted the importance of intrapleural enzyme therapy (IET) involving tissue plasminogen activator (tPA) and DNase in improving radiographic outcomes and reducing surgical referrals. Optimal IET involves administering tPA 10 mg and DNase 5 mg intrapleurally, twice a day for six doses. Criteria for initiating IET include ongoing symptomatic infection despite chest tube drainage and antibiotics.<br /><br />Surgical intervention remains critical for non-responders to medical therapy, with video-assisted thoracoscopic surgery (VATS) proving beneficial, particularly when performed early. Medical thoracoscopy may serve as an option for high-risk patients unsuitable for surgery.<br /><br />Risk stratification tools like the RAPID score help predict outcomes and guide the intensity of interventions. Incorporating these tools in clinical practice could personalize treatment, potentially starting invasive treatment earlier for high-risk patients while adopting conservative approaches for low-risk cases.<br /><br />This comprehensive review points to necessary further prospective studies on individualizing therapy strategies based on risk stratification and optimizing interventions through early and targeted treatments. Future research should also address diagnostic parameters and treatment durations to improve pleural infection management effectively.

Meta Tag

Asset Type PDF

Curriculum Category Pulmonary Disease in Critical Care

Keywords

pleural infection

ERS

ESTS

antibiotic strategy

intrapleural therapies

VATS

RAPID score

tissue plasminogen activator

DNase

risk stratification