Pleural Infection

Question 1

Indications for chest drain

Answer 1

pH <7.2
PF glucose <2.2 AND LDH >1000
Frank pus
Microorganism of gram stain
Positive C&S

Question 2

What is the chest tube size considered as small bore vs large bore

Answer 2

Small bore </=14F
Large bore >/=18F

avoid size </=12 (easily blocked/ dislodge)

for small bore, flush with 30mls NS TDS

Question 3

In which situation a pleural tap does not need to be done in pleural infection?

Answer 3

In small parapneumonic effusion:
<5cm on erect CXR
<2.5cm on CT scan

Question 4

What is the role of IPC in pleural infection, and problem related to it?

Answer 4

Useful in pts with trapped lung, who are not surgical candidates or who decline surgery.

IPC assoc with 4.5% risk of infection.

IPC-assoc. infection usu occur 6w post insertion

Question 5

Landmark trials in pleural infection

Answer 5

tPA + DNA = Intrapleural Enzyme Therapy (IET)

MIST-1: IP STK did not improve outcome in pleural infection pts who have failed std Rx

MIST-2: tPA + DNase improve:
i) radiological clearance
ii) reduced surgical referrals
iii) LOS

Question 6

What is the dose for Intrapleural Enzyme Therapy (IET)?

Answer 6

10mg tPA + 5mg DNase, given BD for 3d