Specific conditions

Para-pneumonic effusions
Patients with simple para-pneumonic effusions usually respond to antibiotics alone and do not require drainage. An effusion is deemed to be complex, therefore requiring drainage, if on aspiration they have either:

• Low fluid pH and glucose or
• Elevated WCC +/- organisms

Para-pneumonic effusions that do not respond to drainage may require intra-pleural fibrinolytic drugs. If these fail, the patient should be referred for surgical intervention.

Malignant effusions

Patients that require drainage are usually treated with pleurodesis (e.g. with intrapleural tetracyclines, talc or bleomycin) to reduce the likelihood of recurrence. Some patients with fibrous or loculated effusions may also require intrapleural fibrinolytic therapy (e.g. with urokinase).

Other approaches to subsequent management include thoracoscopy, intermittent therapeutic drainage (usually those with short life expectancy), long term indwelling pleural catheter and pleuro-peritoneal shunting.