Intrapleural fibrinolysis is a therapeutic procedure used to break down fibrinous septations and loculated fluid collections within the pleural space, typically in the setting of complicated parapneumonic effusions or empyema. It involves instilling fibrinolytic agents into the pleural cavity through a chest tube.
Intrapleural fibrinolysis is used primarily in:
Complicated parapneumonic effusions
Empyema (especially in stage II — fibrinopurulent phase)
Loculated pleural effusions
Patients who are poor surgical candidates for decortication or VATS
Best suited for patients with loculated pleural effusions or empyema in fibrinopurulent stage
Combination of tPA + DNase is now the standard based on clinical evidence
Close monitoring is needed to assess response and watch for complications