Intrapleural Instillation of Sodium Bicarbonate versus Urokinase in Management of Complicated Pleural Effusion: A Comparative Cohort Study

Intrapleural Instillation of Sodium Bicarbonate versus Urokinase in Management of Complicated Pleural Effusion: A Comparative Cohort Study

The main target is evacuation; however, with evidence about the value of intrapleural instillation of different fibrinolytic agents still under evaluation, our aim was comparing the effectiveness and safety of intrapleural instillation of sodium bicarbonate (NaHCO ) in comparison with urokinase in p...

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Bibliographic Details
Published in:International journal of general medicine Vol. 15; pp. 8705 - 8713
Main Authors: Zayed, Niveen E, El Fakharany, Karim, Mehriz Naguib Abozaid, Mohammed
Format: Journal Article
Language:English
Published: New Zealand Dove Medical Press Limited 01-01-2022
Taylor & Francis Ltd
Dove
Dove Medical Press
Subjects:
Bacteria
Biofilms
Carbonates
Cohort analysis
Comparative analysis
fibrinolytic agents
Health aspects
Hemothorax
Iatrogenesis
Infection
Infections
Medical research
Medicine, Experimental
Mortality
nahco3
Observational studies
Original Research
Permeability
Pleural effusion
Pleural effusions
pleural infection
Pneumonia
Pneumothorax
Regression analysis
Sodium
Sodium bicarbonate
Success
Thoracentesis
Tuberculosis
Urokinase
Egypt
United States > US
NaHCO3
pleural infection
fibrinolytic agents
urokinase
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Summary:The main target is evacuation; however, with evidence about the value of intrapleural instillation of different fibrinolytic agents still under evaluation, our aim was comparing the effectiveness and safety of intrapleural instillation of sodium bicarbonate (NaHCO ) in comparison with urokinase in patients with infected pleural effusion. Our prospective cohort study included 40 patients with complicated empyema; the diagnosis was based on analysis of aspirated fluid in association with radiological and bacteriological culture. The patients were subjected to instillation of two different fibrinolytic agents; the first one was NaHCO , the second was urokinase. The commonest underlying chest infection that was visualized by CT was pneumonia 70%. Nearly half of cases had community-acquired infection (45%), and more than half of them (55%) had anaerobic infection, and only five cases had TB pleural effusion based on ADA-positive, tuberculin skin test in addition to Abram's needles closed biopsy. The rate of repeated therapeutic thoracentesis success in each group was 85%; 80% in NaHCO group, and 90% in urokinase group, both of them was significantly equal, =0.37. Moreover, the frequency of complications in all patients was less than 13%, hence hemothorax and iatrogenic pneumothorax was 12.5%, and only 10% of cases were admitted in ICU after the maneuver, with insignificant difference in between the groups. However, looking at the smaller rate of RTT failure of NaHCO or urokinase, the logistic regression model showed that RTT-NaHCO was insignificantly related to failure in both unadjusted and adjusted models, =0.37 and 0.32, respectively, and only smoking habits increase the likelihood of failure 9-fold (OR=8.9, =0.04) with respect to age, sex, and treatment methods. The efficacy of repeated therapeutic thoracentesis (RTT) with intrapleural instillation of NaHCO was effective and safe, the same as urokinase, with consideration that NaHCO was much more available and affordable than urokinase.
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ISSN:1178-7074
1178-7074
DOI:10.2147/IJGM.S388488