BTS guidelines for the management of pleural infection

There is great variation worldwide in the management of patients with pleural infection, and approaches differ between physicians. 1- 14 In the UK up to 40% of empyema patients come to surgery due to failed catheter drainage 4 and, overall, 20% of patients with empyema die. 4 The process of rapid evaluation and therapeutic intervention appears to reduce morbidity and mortality, as well as health care costs. Most forms of pleural infection represent a progressive process that transforms a fluid self-resolving parapneumonic pleural effusion into a complicated multiloculated fibrotic and purulent collection which significantly impairs respiratory reserve and is only amenable to surgical drainage. 1.3 Normal pleural fluid physiology In health, the volume of pleural fluid in humans is small (