The diagnosis and management of pleural empyema

The diagnosis and management of pleural infection continues to improve steadily. Recent advances include: newer, smaller, and more comfortable chest drainage catheters; improved pleural pus drainage with the aid of intrapleural fibrinolytics; and improved surgical procedures including thoracoscopic surgery. The optimal size of chest drainage tube remains a matter of debate, with no large data sets available to clarify the optimal tube size. In contrast, there are now small controlled trials of sound basic methodology which suggest a therapeutic role for both fibrinolytics and thoracoscopy. Studies large enough to establish clearly the efficacy and safety of these approaches are now at the planning and recruitment stage. (C) 1998 Rapid Science Ltd.