Drainage of parapneumonic effusion and thoracic empyema in adults

Indications for drainage of parapneumonic effusion in adults are:

• continued fever and systemic signs of infection despite adequate antibiotic therapy
• large size (more than one-third of the hemithorax)
• loculated pleural effusions
• evidence of continued pleural infection, such as
  • frankly purulent or turbid fluid on sampling
  • presence of bacteria in pleural fluid (on Gram stain or culture)
  • pleural fluid pH less than 7.2
  • pleural fluid lactate dehydrogenase (LDH) concentration more than 1000 units/L.

Empyema of any cause (associated with pneumonia, trauma or an indwelling pleural catheter) always requires drainage.

Drainage may be via intercostal catheter insertion with or without the use of intrapleural enzyme therapy, or surgical decortication.