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Parapnömonik Efüzyonlar ve Ampiyem

Year 2006, Volume: 37 Issue: 1, 29 - 35, 18.07.2014

Cüneyt Tetikkurt

Abstract

Parapnömonik efüzyonlar (PPE) bakterial pnömonilerin en sık komplikasyonlarından biridir. Ayrıca bilinen en eski hastalıklardandır. Böyle olmasına karşılık gerekli girişimlerin gecikmesi yüksek mortalite ile sonuçlanabilmektedir. Klinik tablo, küçük plevral efüzyondan ciddi multiloküler efüzyonlara kadar değişebilmektedir. Her hastanın ciddiyetinin bireysel olarak değerlendirilmesi gerekir. Parapnömonik efüzyon öncelikle direkt grafi ve eğer gerekirse lateral dekübitus, ultrason veya tomografiyle değerlendirilmelidir. İkinci aşamada yapılan torasentez klinisyenin en önemli rehberi niteliğindedir. Torasentezle elde edilen plevra sıvısının biokimyasal özelliklerine göre tedavi şekli belirlenir. Komplike ve komplike olmayan sıvıların ayrımında plevral efüzyonun pH, LDH, glikoz değerleri ile Gram boya ve kültürü büyük önem taşır. Küçük plevral efüzyonlar genellikle antibiyotik tedavisi ile düzelirken komplike veya loküle efüzyonların tedavisi için mutlaka drenaj, fibrinolitikler ya da cerrahi girişim gerekir. PPE'larda başarı için erken tanı ve uygun tedavinin başlanması esastır. PPE'larda bir evreden diğerine geçiş çok hızlı olabildiği için bir terapötik yaklaşımdan sonuç alınabilmesi için beklenecek maksimum süre 3 ile 4 gündür. Terapötik yöntemlerden biri başarsız kaldığında daha invazif bir diğer girişime geçiş için daha fazla beklenmemelidir. Bu nedenle hastanın seri torasentezlerle izlenmesinden kaçınılmamalıdır. Tedavi başarısızlığı ve ciddi komplikasyonların gelişmesinde en önemli neden farklı terapötik girişimler arasındaki sürenin gereksiz yere uzun tutulmasıdır. Parapnömonik efüzyonlu hastaların takibinde göğüs hastalıkları klinisyenleri tedaviyi yönlendirici bir pivot rolü oynarken, radyolog, mikrobiyoloji uzmanları ve göğüs cerrahlarının katkılarından yararlanılmalıdır.

Keywords

Parapnömi efüzyon ampiyem plevral plörezi

References

  • Ferguson AD, Prescott RJ, Selkon JB, Watson D, Swin- burn JR.The clinical course and management of thora- cic empyema. Q J Med 1996; 89: 285-289.
  • Davies CW, Kearney SE, Gleeson FV, Davies RJ. Pre- dictors of outcome and long-term survival in patients with pleural infection. Am J Respir Crit Care Med 1999; 160 : 1682-1687.
  • Light RW. The management of parapneumonic effusi- ons and empyema. Pneumon 2002; 15: 127-132.
  • Alfagame I, Munoz F, Pena U, Umbria S. Empyema of the thorax in adults. Chest 1993; 103: 839-843.
  • Everts RJ, Reller LB. Pleural space infections: micro- biology and antimicrobial therapy. Semin Respir In- fect 1999; 14: 18-30.
  • Bouros D, Platki M, Schiza SE. Parapneumonic pleural effusions and empyema. Pleural Disease'de.Ed.Bouros D.New York, Marcel Dekker, 2004; 353-389.
  • Antony VB, Mohammed KA. Pathophysiology of ple- ural infections. Semin Respir Infect 1999; 14: 9-17.
  • Barlett JG, Finegold SM. Anaerobic infections of the lung and pleural space. Am Rev Respir Dis 1974; 110: 56-77.
  • LeMense GP, Strange C, Sahn SA. Empyema thoracis- therapeutic management and outcome. Chest 1995; 107: 1532-1537.
  • Light RW. A new classification of parapneumonic ef- fusions and empyema. Chest 1995; 108: 299-301.
  • Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B, Sahn S, Weinstein RA, Yusen RD. Medi- cal and surgical treatment of parapneumonic effusions. Chest 2000; 18: 1158-1171.
  • Niederman MS, Mandell LA,Anzueto A ve ark. Guide- lines for the management of adults with community- acquired pnemonia. Diagnosis, assesment of severity, antimicrobial therapy and prevention. Am J Respir Crit Care Med 2001; 163: 1730-1754.
  • Blackmore CC, Black WC, Dallas RV ve ark. Pleural volume estimation: a chest radiograph prediction ru- le. Acad Radiol 1996; 3: 103-109.
  • Muller NL. Imaging of the pleura. Radiology 1993; 186: 297-309.
  • Yang PC, Luh KT, Chang DB, Wu HD, Yu CJ, Kuo SH. Value of sonography in determining the nature of pleural effusions: analysis of 320 cases. AJR 1992; 159: 29-33.
  • Kearney SE, Davies CW, Davies RJ, Gleeson FV. Com- puted tomography and ultrasound in parapneumonic effusions and in empyema. Clin Radiol 2000; 55: 542-547.
  • Kearney SE, Davies CW, Tattersall DJ, Gleeson FV. The characteristics and significance of thoracic lymp- hadenopathy in parapneumonic effusion and empye- ma. Br J Radiol 2000; 73: 583-587.
  • Heffner JE, Brown LK, Barbieri C, DeLeo JM. Am J Res- pir Crit Care Med 1995; 151: 1701-1708.
  • Light RW, Rodriguez RM. Management of parapneu- monic effusions. Clin Chest Med 1998; 19; 373-382.
  • Sahn SA.State of art.The pleura.Am Rev Respir Dis 1988; 138: 284-288.
  • Lemmer JH, Botham MJ, Orringer MB.Modern mana- gement of adult thoracic empyema.J Thoracic Cardio- vasc Surg 1985; 90; 849-885.
  • Strange C, Sahn SA.Management of parapneumonic pleural effusions and empyema.Infect Dis Clin North Am 1991; 5: 539-559.
  • Teixira LR, Sasse SA, Villarino MA, Nguyen T, Mulli- gan ME, Light RW.Antibiotic levels in empyemic ple- ural fluid.Chest 2000; 117: 1734-1739.
  • Strom HK, Krasnik M, Bang K, Frimodt-Moller N.Treat- ment of pleural empyema secondary to pneumonia: thoracentesis regimen versus tube drainage.Thorax 1992; 47: 821-824.
  • Bouros D, Hamm H.Infectious pleural effusions.Eur Respir Mon 2002; 22: 204-218.
  • Ferguson AD, Presott RJ, Selkon JB, Watson D, Swin- burn CR.The clinical course and management of tho- racic empyema.QJM 1996; 89: 285-289.
  • Bouros D, Schiza S, Siafakas N.Fibrinolytics in the treatment of parapneumonic effusions.Monaldi Arch Chest Dis 1999; 54: 558-563.
  • Bouros D, Schiza S, Siafakas N.Utility of fibrinolytic agents for draining intrapleural infection.Semin Respir Infect 1999; 14: 39-47.
  • Loddenkemper R.Thoracoscopy-state of the art.Eur Respir J 1998; 11; 213-221.
  • Lackner RP, Hughes R, Anderson LA, Sammut PH, Thompson A.Video-assisted evacuation of empyema is the preffered procedure for the management of ple- ural space infections.Am J Surg 2000; 179: 27-30.
  • Cunniffe MG, Maguire D, McAnena OJ, Johnston S, Gilmartin JJ.Video-assisted thoracoscopic surgery in the management of loculated empyema.Surg Endosc 2000; 14:175-178.
  • Muskett A, Burton NA, Karwande SV, Collins MP. Ma- nagement of refractory empyema with early decorti- cation. Am J Surg 1988; 156: 529-532.
  • Mackinlay TAA, Lyons GA, Chimondeguy DJ, Piefras MAB, Angaramo G, Emery J.VATS debridement versus thoracotomy in the treatment of loculated postpneu- monia empyema. Ann Thoracic Surg 1996; 61: 1626- 1630.
  • Hamm H, Light RW.Parapneumonic effusion and emp- yema. Eur Respir J 1997; 10: 1150-1156.

Year 2006, Volume: 37 Issue: 1, 29 - 35, 18.07.2014

Cüneyt Tetikkurt

Abstract

References

  • Ferguson AD, Prescott RJ, Selkon JB, Watson D, Swin- burn JR.The clinical course and management of thora- cic empyema. Q J Med 1996; 89: 285-289.
  • Davies CW, Kearney SE, Gleeson FV, Davies RJ. Pre- dictors of outcome and long-term survival in patients with pleural infection. Am J Respir Crit Care Med 1999; 160 : 1682-1687.
  • Light RW. The management of parapneumonic effusi- ons and empyema. Pneumon 2002; 15: 127-132.
  • Alfagame I, Munoz F, Pena U, Umbria S. Empyema of the thorax in adults. Chest 1993; 103: 839-843.
  • Everts RJ, Reller LB. Pleural space infections: micro- biology and antimicrobial therapy. Semin Respir In- fect 1999; 14: 18-30.
  • Bouros D, Platki M, Schiza SE. Parapneumonic pleural effusions and empyema. Pleural Disease'de.Ed.Bouros D.New York, Marcel Dekker, 2004; 353-389.
  • Antony VB, Mohammed KA. Pathophysiology of ple- ural infections. Semin Respir Infect 1999; 14: 9-17.
  • Barlett JG, Finegold SM. Anaerobic infections of the lung and pleural space. Am Rev Respir Dis 1974; 110: 56-77.
  • LeMense GP, Strange C, Sahn SA. Empyema thoracis- therapeutic management and outcome. Chest 1995; 107: 1532-1537.
  • Light RW. A new classification of parapneumonic ef- fusions and empyema. Chest 1995; 108: 299-301.
  • Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B, Sahn S, Weinstein RA, Yusen RD. Medi- cal and surgical treatment of parapneumonic effusions. Chest 2000; 18: 1158-1171.
  • Niederman MS, Mandell LA,Anzueto A ve ark. Guide- lines for the management of adults with community- acquired pnemonia. Diagnosis, assesment of severity, antimicrobial therapy and prevention. Am J Respir Crit Care Med 2001; 163: 1730-1754.
  • Blackmore CC, Black WC, Dallas RV ve ark. Pleural volume estimation: a chest radiograph prediction ru- le. Acad Radiol 1996; 3: 103-109.
  • Muller NL. Imaging of the pleura. Radiology 1993; 186: 297-309.
  • Yang PC, Luh KT, Chang DB, Wu HD, Yu CJ, Kuo SH. Value of sonography in determining the nature of pleural effusions: analysis of 320 cases. AJR 1992; 159: 29-33.
  • Kearney SE, Davies CW, Davies RJ, Gleeson FV. Com- puted tomography and ultrasound in parapneumonic effusions and in empyema. Clin Radiol 2000; 55: 542-547.
  • Kearney SE, Davies CW, Tattersall DJ, Gleeson FV. The characteristics and significance of thoracic lymp- hadenopathy in parapneumonic effusion and empye- ma. Br J Radiol 2000; 73: 583-587.
  • Heffner JE, Brown LK, Barbieri C, DeLeo JM. Am J Res- pir Crit Care Med 1995; 151: 1701-1708.
  • Light RW, Rodriguez RM. Management of parapneu- monic effusions. Clin Chest Med 1998; 19; 373-382.
  • Sahn SA.State of art.The pleura.Am Rev Respir Dis 1988; 138: 284-288.
  • Lemmer JH, Botham MJ, Orringer MB.Modern mana- gement of adult thoracic empyema.J Thoracic Cardio- vasc Surg 1985; 90; 849-885.
  • Strange C, Sahn SA.Management of parapneumonic pleural effusions and empyema.Infect Dis Clin North Am 1991; 5: 539-559.
  • Teixira LR, Sasse SA, Villarino MA, Nguyen T, Mulli- gan ME, Light RW.Antibiotic levels in empyemic ple- ural fluid.Chest 2000; 117: 1734-1739.
  • Strom HK, Krasnik M, Bang K, Frimodt-Moller N.Treat- ment of pleural empyema secondary to pneumonia: thoracentesis regimen versus tube drainage.Thorax 1992; 47: 821-824.
  • Bouros D, Hamm H.Infectious pleural effusions.Eur Respir Mon 2002; 22: 204-218.
  • Ferguson AD, Presott RJ, Selkon JB, Watson D, Swin- burn CR.The clinical course and management of tho- racic empyema.QJM 1996; 89: 285-289.
  • Bouros D, Schiza S, Siafakas N.Fibrinolytics in the treatment of parapneumonic effusions.Monaldi Arch Chest Dis 1999; 54: 558-563.
  • Bouros D, Schiza S, Siafakas N.Utility of fibrinolytic agents for draining intrapleural infection.Semin Respir Infect 1999; 14: 39-47.
  • Loddenkemper R.Thoracoscopy-state of the art.Eur Respir J 1998; 11; 213-221.
  • Lackner RP, Hughes R, Anderson LA, Sammut PH, Thompson A.Video-assisted evacuation of empyema is the preffered procedure for the management of ple- ural space infections.Am J Surg 2000; 179: 27-30.
  • Cunniffe MG, Maguire D, McAnena OJ, Johnston S, Gilmartin JJ.Video-assisted thoracoscopic surgery in the management of loculated empyema.Surg Endosc 2000; 14:175-178.
  • Muskett A, Burton NA, Karwande SV, Collins MP. Ma- nagement of refractory empyema with early decorti- cation. Am J Surg 1988; 156: 529-532.
  • Mackinlay TAA, Lyons GA, Chimondeguy DJ, Piefras MAB, Angaramo G, Emery J.VATS debridement versus thoracotomy in the treatment of loculated postpneu- monia empyema. Ann Thoracic Surg 1996; 61: 1626- 1630.
  • Hamm H, Light RW.Parapneumonic effusion and emp- yema. Eur Respir J 1997; 10: 1150-1156.
There are 34 citations in total.

Details

Primary Language Turkish
Journal Section Derlemeler
Authors

Cüneyt Tetikkurt This is me

Publication Date July 18, 2014
Published in Issue Year 2006 Volume: 37 Issue: 1

Cite

APA Tetikkurt, C. (2014). Parapnömonik Efüzyonlar ve Ampiyem. Cerrahpaşa Tıp Dergisi, 37(1), 29-35.
AMA Tetikkurt C. Parapnömonik Efüzyonlar ve Ampiyem. Cerrahpaşa Tıp Dergisi. July 2014;37(1):29-35.
Chicago Tetikkurt, Cüneyt. “Parapnömonik Efüzyonlar Ve Ampiyem”. Cerrahpaşa Tıp Dergisi 37, no. 1 (July 2014): 29-35.
EndNote Tetikkurt C (July 1, 2014) Parapnömonik Efüzyonlar ve Ampiyem. Cerrahpaşa Tıp Dergisi 37 1 29–35.
IEEE C. Tetikkurt, “Parapnömonik Efüzyonlar ve Ampiyem”, Cerrahpaşa Tıp Dergisi, vol. 37, no. 1, pp. 29–35, 2014.
ISNAD Tetikkurt, Cüneyt. “Parapnömonik Efüzyonlar Ve Ampiyem”. Cerrahpaşa Tıp Dergisi 37/1 (July 2014), 29-35.
JAMA Tetikkurt C. Parapnömonik Efüzyonlar ve Ampiyem. Cerrahpaşa Tıp Dergisi. 2014;37:29–35.
MLA Tetikkurt, Cüneyt. “Parapnömonik Efüzyonlar Ve Ampiyem”. Cerrahpaşa Tıp Dergisi, vol. 37, no. 1, 2014, pp. 29-35.
Vancouver Tetikkurt C. Parapnömonik Efüzyonlar ve Ampiyem. Cerrahpaşa Tıp Dergisi. 2014;37(1):29-35.