Mohan, A S (2020) Comparison of Effectiveness of Intrapleural Instillation of Sodium 2 Mercaptoethane Sulfonate (MESNA) with Tube Thoracostomy Versus Conservative Management with Tube Thoracostomy alone in Loculated Parapneumonic Pleural Effusion/Empyema. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION : Management of loculated parapneumonic effusion or empyema with closed pleural aspiration and Intercostal drainage often fails leading to organized effusion, persistent pleural sepsis, septic shock, bronchopleural fistula, trapped lung. Loculated parapneumonic patients with failed closed pleural drainage need thoracoscopy and surgical interventions. Intrapleural fibrinolytic therapy by enchancing pleural fluid drainage can alleviate these complications and reduces the requirement of surgical intervention. MESNA (2- mercapethanesulfonatesodium) a mucolytic agent with additional proteolytic activity, used earlier in studies as fibrinolytic agent in parapneumonic effusions and empyema with variable success. The number of studies on intrapleural fibrinolytic therapy with MESNA were limited. AIM OF THE STUDY: To evaluate the effectiveness of intrapleural instillation of MESNA in faster clearance of loculated paraneumonic effusions/Empyema and to compare its efficacy with conservative management. OBJECTIVES: 1. To evaluate the usefulness of MESNA in faster absorption of exudative loculated pleural effusion/empyema. 2. To assess the effectiveness of MESNA in breaking up the loculations. 3. To assess the clinical safety profile of intrapleural instillation of MESNA 4. To compare efficacy of MESNA with conservative management. MATERIALS AND METHODS: It was hospital based randomized open label controlled trail conducted after approval by institutional ethical committee. 70 parapneumonic pleural effusion and empyema patients were included in the study after informed consent and divided into two groups by simple randomization. Each group will have 35 patients which includes 25 parapneumonic effusion and 10 empyema patients. One group will receive 3 doses of 240 mg per metre square body surface area of MESNA intrapleurally either percutaneously or through ICD under image guidance. Other group managed conservatively with tube thoracostomy alone which acts as control. Patients were followed up and results were tabulated and analysed. RESULTS: In MESNA group fibrinolysis was successful in 20 out of 25 loculated effusions (80% success rate ) and 3 out 10 loculated empyema patients (30% success rate). MESNA group had significant increase in volume of drain per day (138 ml/day vs 85 ml/day, p <0.001), reduced duration of intercostal drainage tube (14.1 vs 21.1 days p value <0.001), reduced length of hospital stay (21.7 days vs 29.9 days, p < 0.001). Number of patients requiring thoracoscopy and surgical intervention were less in MESNA group when compared to control. No major adverse events reported following intrapleural instillation of MESNA during the study period. CONCLUSION: 2- mercaptoethanesulfonate sodium (MESNA) is an efficacious intrapleural fibrinolytic agent in breaking loculations and faster absorption of pleural fluid in parapneumonic effusion and empyema. Intrapleural instillation of MESNA in early stages of parapneumonic effusion will have better results and reduce the need for surgical interventions. MESNA is a safe drug for intarpleural fibrinolytic therapy. MESNA can be a preferred intrapleural fibrinolytic agent.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201727054 |
| Uncontrolled Keywords: | Multiloculated parapneumonic effusion/empyema, failed closed pleural drainage, intrapleural fibrinolytic therapy, 2- mercaptoethane sulfonate sodium (MESNA), adhesiolysis, tube thoracostomy, comparison, efficacy, safety. |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 04 Feb 2021 16:08 |
| Last Modified: | 04 Feb 2021 16:08 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13807 |
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