Intrapleural Enzymatic Debridement With Tryptar

The cases presented illustrate some of the situations in which the pancreatic enzyme trypsin can be used for the purpose of selective intrapleural proteolytic debridement. These included tuberculous empyema, tuberculous infection of the extrapleural space, mixed tuberculous empyema, non-tuberculous empyema following resection for tuberculosis, non-tuberculous postoperative empyema, and non-specific bilateral pleural effusion of an indeterminant nature. [SEE FIGURE 12 AND FIGURE 13 IN SOURCE PDF]

Complete cure was obtained in the two cases of tuberculous empyema and the two cases of postoperative empyema, and almost complete relief obtained in the case of bilateral effusion of unknown origin. Improvement as manifested by decrease in viscosity and sterilization of the fluid was noted in the other three cases and contributed to eventual good surgical results in this manner. Following these initial encouraging experiences, tryptic debridement has subsequently been employed in an additional 22 patients with comparable results. In addition to the above mentioned indications, this method has been successfully used in the treatment of postoperative and traumatic hemothorax.

It is concluded that tryptic debridement is a valuable adjunct in the treatment of intrapleural infections and hemothorax and is deserving of more widespread usage. Side effects are few and inconsequential. Its use is not necessarily contraindicated in the presence of bronchopleural fistula.