Spectrum Health Health Pleural Infection Management Inpatient Instructions
- June 13, 2024
- Spectrum Health
Table of Contents
Clinical Pathways Program
Guideline: Pleural Infection Management, Inpatient
Updated: October 25, 2021
Clinical algorithm:
Clinical pathway/guideline summary
CLINICAL PATHWAY/GUIDELINE NAME: Pleural Infection Management
PATIENT POPULATION AND DIAGNOSIS: All patients with suspected pleural
infection
APPLICABLE TO: Spectrum Health Grand Rapids ONLY (Butterworth & Blodgett)
BRIEF DESCRIPTION: Treatment algorithm for the diagnosis and management
of pleural infections including simple parapneumonic effusions, complex
parapneumonic effusions, and empyema.
OVERSIGHT TEAM LEADER(S): John Egan, MD
OWNING EXPERT IMPROVEMENT TEAM (EIT): N/A
MANAGING CLINICAL PRACTICE COUNCIL (CPC): Specialty Health
CPC APPROVAL DATE: 10/18/2021
OTHER TEAM(S) IMPACTED: Hospital medicine, interventional radiology,
pulmonary consult, infectious disease consult, thoracic surgery
IMPLEMENTATION DATE: October 2021
LAST REVISED: October 25, 2021
FOR MORE INFORMATION, CONTACT: John Egan, MD
Clinical pathways clinical approach
TREATMENT AND MANAGEMENT: **
**
This pathway allows for expeditious diagnosis and treatment of pleural infections requiring hospital admission. Pleural infections represent a continuation of pneumonia and persistent infection and often require drainage. Drainage maybe challenging or incomplete given these infections propensity to cause loculations and pus in the pleural space. Chest tube drainage and antibiotics alone may not obviate the need for thoracic surgery. Since the publishing of MIST II, more and more evidence has shown the benefit of instilling intrapleural lytics to break up loculations and pus and allow for complete drainage of pleural infection. Specifically, tissue plasminogen activator (tPA) and dornase alpha, when given in combination, can improve pleural infection drainage and allow patients to avoid surgery.
REFERENCES:
- Intrapleural use of tissue plasminogen activator and DNase in pleural infection. Rahman NM, Maskell NA, West A, Teoh R, et al. N Engl J Med 2011;365:518-526
- Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010. Davies HE, Davies, RJO, Davies, CHW, BTS pleural disease guideline group. Thorax 2010;65(Suppl 2):ii41-ii53