Malattie dell'apparato respiratorio - il versamento pleurico parapneumotico

VERSAMENTO

PARAPNEUMONICO

Light’s classification of parapneumonic effusion

and empyema

CLASS 1 NON SIGNIFICANT PLEURAL EFFUSION

small, < 10mm thick on rx-ll

NO TORACENTESIS INDICATED

CLASS 2 TYPICAL PARAPNEUMONIC PLEURAL EFFUSION

> 10 mm thick

glucosio > 40

pH > 7,20

LDH > 3 x upper limit normal for serum

Gram’s stain and colture negative

ANTIBIOTICS ALONE

Light’s classification of parapneumonic effusion

and empyema

CLASS 3 BORDERLINE COMPLICATED PLEURAL EFFUSION

glucosio > 40

pH 7,00 - 7,20

LDH > 3 x upper limit normal for serum

Gram’s stain and colture negative

ANTIBIOTICS + SERIAL TORACENTESIS

CLASS 4 SIMPLE COMPLICATED PLEURAL EFFUSION

NOT LOCULATED – NOT FRANK PUS

glucosio < 40

pH < 7,00

LDH > 3 x upper limit normal for serum

Gram’s stain and colture POSITIVE

ANTIBIOTICS + TUBE TORACOSTOMY

Light’s classification of parapneumonic effusion

and empyema

CLASS 5 COMPLEX COMPLICATED PLEURAL EFFUSION

LOCULATED – NOT FRANK PUS

glucosio < 40

pH < 7,00

LDH > 3 x upper limit normal for serum

Gram’s stain and colture POSITIVE

TUBE TORACOSTOMY + FIBRINOLITICS

“ … rarely require thoracoscopy or decortication … “

CLASS 6 SIMPLE EMPYEMA

FRANK PUS PRESENT ( single locule or free flowing )

TUBE TORACOSTOMY and ( DECORTICATION )

CLASS 7 COMPLEX EMPYEMA

FRANK PUS PRESENT ( multiple locules )

TUBE TORACOSTOMY + FIBRINOLITICS

“ … often require thoracoscopy or decortication … “

VERSAMENTO PLEURICO PARAPNEUMONICO COMPLESSO

O EMPIEMA PLEURICO COMPLESSO ( CLASSE V E VII )

UTILITA’ DELLA TORACOSCOPIA

•DELOCULAZIONE

• LISI DELLE ADERENZE

• IMPEDIRE L’INCARCERAMENTO POLMONARE

• FAVORIRE LA RIESPANSIONE POLMONARE

• PERMETTERE UN ADEGUATO POSIZIONAMENTO DEL TUBO

• ESCLUDERE UNA ETIOLOGIA NEOPLASTICA ( 2-4% )