Management of parapneumonic pleural effusion in adults

array:24 ["pii" => "S1579212915003158" "issn" => "15792129" "doi" => "10.1016/j.arbr.2015.10.002" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1133" "copyright" => "SEPAR" "copyrightAnyo" => "2014" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Arch Bronconeumol. 2015;51:637-46" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 11430 "formatos" => array:3 [ "EPUB" => 171 "HTML" => 8416 "PDF" => 2843 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289615000769" "issn" => "03002896" "doi" => "10.1016/j.arbres.2015.01.009" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1133" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Arch Bronconeumol. 2015;51:637-46" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 75218 "formatos" => array:3 [ "EPUB" => 190 "HTML" => 64501 "PDF" => 10527 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Revisión" "titulo" => "Manejo del derrame pleural paraneumónico en adultos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "637" "paginaFinal" => "646" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Management of Parapneumonic Pleural Effusion in Adults" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1819 "Ancho" => 2903 "Tamanyo" => 433718 ] ] "descripcion" => array:1 [ "es" => "A)Derrame pleural anecoico. B)Derrame pleural con múltiples septos y loculaciones. L: loculación; LP: líquido pleural; S: septo." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lucía Ferreiro, María Esther San José, Luis Valdés" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Lucía" "apellidos" => "Ferreiro" ] 1 => array:2 [ "nombre" => "María Esther" "apellidos" => "San José" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Valdés" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212915003158" "doi" => "10.1016/j.arbr.2015.10.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003158?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615000769?idApp=UINPBA00003Z" "url" => "/03002896/0000005100000012/v2_201511280826/S0300289615000769/v2_201511280826/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212915003031" "issn" => "15792129" "doi" => "10.1016/j.arbr.2015.09.012" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1150" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Arch Bronconeumol. 2015;51:647-53" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4850 "formatos" => array:3 [ "EPUB" => 155 "HTML" => 3571 "PDF" => 1124 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Review" "titulo" => "Updates on Aspergillus, Pneumocystis and Other Opportunistic Pulmonary Mycoses" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "647" "paginaFinal" => "653" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actualización sobre Aspergillus, Pneumocystis y otras micosis pulmonares oportunistas" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1074 "Ancho" => 1614 "Tamanyo" => 90993 ] ] "descripcion" => array:1 [ "en" => "Association between degree of immunodeficiency and type of pulmonary aspergillosis." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Curbelo, José María Galván, Javier Aspa" "autores" => array:3 [ 0 => array:2 [ "nombre" => "José" "apellidos" => "Curbelo" ] 1 => array:2 [ "nombre" => "José María" "apellidos" => "Galván" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Aspa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S030028961500099X" "doi" => "10.1016/j.arbres.2015.02.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028961500099X?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003031?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000012/v1_201512080104/S1579212915003031/v1_201512080104/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212915003122" "issn" => "15792129" "doi" => "10.1016/j.arbr.2015.09.021" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1065" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2015;51:632-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3184 "formatos" => array:3 [ "EPUB" => 153 "HTML" => 2211 "PDF" => 820 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Long-term Outcome of Patients with Undiagnosed Pleural Effusion" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "632" "paginaFinal" => "636" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resultados del seguimiento a largo plazo de pacientes con derrame pleural no diagnosticado" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gulsah Gunluoglu, Aysun Olcmen, Mehmet Zeki Gunluoglu, Ibrahim Dincer, Adnan Sayar, Gungor Camsari, Veysel Yilmaz, Sedat Altin" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Gulsah" "apellidos" => "Gunluoglu" ] 1 => array:2 [ "nombre" => "Aysun" "apellidos" => "Olcmen" ] 2 => array:2 [ "nombre" => "Mehmet Zeki" "apellidos" => "Gunluoglu" ] 3 => array:2 [ "nombre" => "Ibrahim" "apellidos" => "Dincer" ] 4 => array:2 [ "nombre" => "Adnan" "apellidos" => "Sayar" ] 5 => array:2 [ "nombre" => "Gungor" "apellidos" => "Camsari" ] 6 => array:2 [ "nombre" => "Veysel" "apellidos" => "Yilmaz" ] 7 => array:2 [ "nombre" => "Sedat" "apellidos" => "Altin" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614003901" "doi" => "10.1016/j.arbres.2014.09.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614003901?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003122?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000012/v1_201512080104/S1579212915003122/v1_201512080104/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Review" "titulo" => "Management of parapneumonic pleural effusion in adults" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "637" "paginaFinal" => "646" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lucía Ferreiro, María Esther San José, Luis Valdés" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Lucía" "apellidos" => "Ferreiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "María Esther" "apellidos" => "San José" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 2 => array:4 [ "nombre" => "Luis" "apellidos" => "Valdés" "email" => array:1 [ 0 => "luis.valdes.cuadrado@sergas.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Análisis Clínicos, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo del derrame pleural paraneumónico en adultos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from Bhatnagar and Maskell.<a class="elsevierStyleCrossRef" href="#bib0430">16</a>" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2661 "Ancho" => 4167 "Tamanyo" => 500173 ] ] "descripcion" => array:1 [ "en" => "Physiopathology, appearance, biochemical parameters and microbiology of parapneumonic pleural effusion." ] ] ] "textoCompleto" => "IntroductionParapneumonic pleural effusion (PPE) refers to a pleural effusion (PE) associated with bacterial pneumonia, a pulmonary abscess, or infected bronchiectasis.<a class="elsevierStyleCrossRef" href="#bib0355">1</a> When not accompanied by parenchymal disease, it is known as a pleural infection (PI) or complicated PE (CPE). Although most PPEs can be resolved with antibiotic treatment alone, a subgroup of patients can present severe complications, such as: PPE refractory to antibiotic treatment and chest drainage (CD), requiring surgical drainage (33%)<a class="elsevierStyleCrossRef" href="#bib0360">2</a>; pleural fibrosis (14%); prolonged hospital stay (mean 12–15 days and >1 month in 25% of cases)<a class="elsevierStyleCrossRefs" href="#bib0360">2,4,5</a>; and high mortality rates (10–20%).<a class="elsevierStyleCrossRefs" href="#bib0360">2,4,6</a> In order to avoid these, a firm diagnosis must be reached as soon as possible, and close clinical monitoring established.EpidemiologyOf the one million patients hospitalized annually in the United States for pneumonia, around 60,000 will present empyema, and a further 25,000 will develop it for other reasons.<a class="elsevierStyleCrossRef" href="#bib0385">7</a> Despite clinical advances, the incidence of PI, irrespective of its stage of development, is increasing worldwide<a class="elsevierStyleCrossRefs" href="#bib0375">5,8</a> across all age groups.<a class="elsevierStyleCrossRefs" href="#bib0395">9–11</a> In the United States, the rate of hospitalization for empyema doubled from 1996 to 2008 (from 3.04 to 5.98/100,000 population), across all age groups.<a class="elsevierStyleCrossRef" href="#bib0410">12</a>PhysiopathologyThere are 3 phases in the evolution of PPE. In the first (exudative) phase, pleural fluid (PF) forms as a consequence of localized inflammation and activation of the immune system. The activated neutrophils can cause an endothelial lesion, which will increase capillary permeability and lead to onset of PE.<a class="elsevierStyleCrossRefs" href="#bib0415">13,14</a> The pleural damage can lead to commencement of the second phase (fibrinopurulent), with the activation of pro-inflammatory and pro-fibrinotic components, and initiation of the coagulation cascade. The local inflammatory response is thus amplified by the presence of various cytokines, which stimulate chemotaxis of neutrophils and fibroblasts.<a class="elsevierStyleCrossRef" href="#bib0420">14</a> Furthermore, membrane permeability can allow bacteria to enter the pleural space. In the latter stages of this phase, PF resembling empyema may be observed due to the presence of cellular degradation products and bacterial remains. During this period, there is also a decrease in fibrinolysis, thereby increasing fibrin formation in the pleural space. This process can progress to the final (organizing) phase, in which a layer of fibrosis is formed on both pleural surfaces due to the increase in fibroblastic infiltration. As a result, these cases can be extremely difficult to manage without resorting to surgery<a class="elsevierStyleCrossRefs" href="#bib0425">15,16</a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The appearance, analysis and culture of PE can vary in each of the evolutionary phases of PPE. The physiopathological changes that take place in the pleural space mean that, from a clinical point of view, PPE can be classified as: uncomplicated PPE (UPPE), which is resolved with antibiotic treatment; complicated PPE (CPPE), which will require CD or surgery for resolution; and empyema, i.e. the presence of pus in the pleural space, which must always be drained.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>DiagnosisDiagnosing PPE is not complex in patients presenting with classic symptoms, which are similar to pneumonia.<a class="elsevierStyleCrossRef" href="#bib0435">17</a> A poor response to pneumonia therapy could suggest the presence of a PPE or empyema as a complication of the disease.<a class="elsevierStyleCrossRef" href="#bib0440">18</a> It is sometimes difficult to suspect a PI, as the symptoms are atypical, and there is no evidence of pneumonia on chest radiograph.<a class="elsevierStyleCrossRef" href="#bib0445">19</a> Blood cultures are only positive in 12% of cases, PF culture is negative in more than 40% of samples<a class="elsevierStyleCrossRef" href="#bib0360">2</a> and, occasionally, the microorganisms responsible are very rare and can only be identified by molecular microbiology.<a class="elsevierStyleCrossRef" href="#bib0450">20</a> Although the criteria for defining CPPEs are well established,<a class="elsevierStyleCrossRef" href="#bib0435">17</a> there are no clinical or radiological data to determine which patients will go on to develop CPPE/empyema. As these are easily identifiable by their appearance, the difficulty lies in detecting (as early as possible) which patients with non-purulent PPE might progress to CPPE. Various diagnostic methods have been used for this purpose, but results have so far been disappointing.Pneumonia severity scales and scoresPneumonia severity scales<a class="elsevierStyleCrossRefs" href="#bib0440">18,21</a> have been used to predict 30-day mortality following admission, but not to assess the likelihood of developing CPPE/empyema. Chalmers et al.<a class="elsevierStyleCrossRef" href="#bib0460">22</a> showed that these scales and generic sepsis scoring systems (APACHE II, SEWS and SIRS) cannot predict the development of CPPE/empyema. However, multivariate logistic regression has identified that: albumin<30g/l, Na<130mmol/l, platelet count>400,000, C-reactive protein (CRP)>100mg/l and a history of alcohol abuse and intravenous drug use are independent risk factors for CPPE/empyema.<a class="elsevierStyleCrossRef" href="#bib0460">22</a>Rahman et al.<a class="elsevierStyleCrossRef" href="#bib0465">23</a> developed a validated clinical risk score (RAPID) to identify patients with PI and high risk of dying, to enable clinicians to implement the best management strategy. The score includes urea levels, age, presence of purulent PF, source of infection (community or hospital), and dietary factors (albumin). Patients can then be divided into low, medium and high-risk groups according to the score. The odds ratio for mortality at 3 months for the medium- and high-risk groups, using the low-risk group as a reference, is 24.4 and 192.4, respectively. Using this system, patients with PI at presentation can be stratified according to risk.Imaging testsRadiographs, chest ultrasound (CU) and chest computed tomography (CT) can provide information on the size, extent and nature of the PE. PF volumes of >200–250cm3 are usually seen on the chest radiograph, and CPPE may be suspected if opacification of the pleural space does not change with the gravitational effects of the PF.CU is a key technique in the management of PE, particularly PPE, and pulmonologists must be competent in its use. It is more sensitive than radiography for detecting minor PE, establishes the echogenicity of the PF, precisely locates the loculated fluid, estimates the volume and depth of the PE, differentiates between PF and underlying consolidation or atelectasia, improves the yield of thoracocentesis, and reduces the risk of complications compared to physical examination plus radiography.<a class="elsevierStyleCrossRef" href="#bib0470">24</a> An ultrasound finding of septa suggests CPPE (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), and hyperechogenicity is associated with pus in the pleural cavity.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>CT provides the clearest image of the pleura, and can be used to reconstruct images, determine loculations, and reveal lesions in the underlying lung. It also differentiates between a peripheral pulmonary abscess and a loculated PI, though the split pleura sign.<a class="elsevierStyleCrossRef" href="#bib0475">25</a>CU, being radiation-free and easily performed at the bedside in critically ill patients, should be the technique of choice. Factors that may affect image quality, such as obesity or subcutaneous emphysema, and suspicion of malignant PE or pleural infection with comorbidity (esophageal rupture, bronchopleural fistula, etc.), in which other anatomical abnormalities must be identified, may make it necessary to perform a CT scan.MicrobiologyA positive PF culture is diagnostic of PI, but this only occurs in 58% of cases. This proportion increases to 74% if molecular microbiology is used.<a class="elsevierStyleCrossRef" href="#bib0450">20</a> PI is thought to occur as a result of migration of the bacteria present in the lung parenchyma, so such infections are usually called CPPEs, on the assumption that the bacterial etiology of all PIs is the same as that of pneumonia. However, in a review of 14 studies with a total of 1383 patients with empyema, only 70% were due to pneumonia and the rest were due to other causes.<a class="elsevierStyleCrossRef" href="#bib0480">26</a> Therefore, basing the choice of antibiotic for treating PI on this assumption is not the best strategy, as there are major bacteriological differences between PI and pneumonia.<a class="elsevierStyleCrossRef" href="#bib0450">20</a> These differences are probably due to significant differences in acidity and oxygenation between the infected pleural space and the ventilated lung, thus predisposing it to invasion by certain organisms over others.<a class="elsevierStyleCrossRef" href="#bib0485">27</a> There are also differences (as regards the types of microorganisms) between community- and hospital-acquired PIs<a class="elsevierStyleCrossRef" href="#bib0450">20</a> (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>The heptavalent pneumococcal vaccine could play a major role in the evolution of the microbiology of PI, since it has been observed that the predominant serotypes that cause PI are those not covered by the vaccine.<a class="elsevierStyleCrossRef" href="#bib0490">28</a> This seems to correlate with a significant increase in the incidence of empyema,<a class="elsevierStyleCrossRef" href="#bib0495">29</a> which suggests an increase in the virulence of the new microorganisms.Pleural fluid analysisThe combination of clinical symptoms, physical examination, blood tests and chest radiography usually confirms the presence of pneumonia with PPE. PF analysis is the most reliable method for diagnosing the condition, and for trying to prevent progression to CPPE.<a class="elsevierStyleCrossRef" href="#bib0500">30</a> Thoracocentesis is therefore recommended in all patients with suspected infectious PE if the pleural fluid thickness in the chest radiograph obtained in lateral decubitus is >10mm,<a class="elsevierStyleCrossRef" href="#bib0445">19</a> although the likelihood of a PPE<2cm in depth on the CT scan progressing to CPPE is small.<a class="elsevierStyleCrossRef" href="#bib0505">31</a>PF analysis can vary in each of the evolutionary phases of PPE. The tests to be performed when PPE is suspected are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. A UPPE is a polymorphonuclear (PMN) predominant exudate with a serous appearance, normal biochemical findings, and negative culture. If the patient has previously received antibiotics, the nucleated cells will be predominantly lymphocytic.<a class="elsevierStyleCrossRef" href="#bib0510">32</a> Biochemistry tests in PF, however, are most useful as a tool for early detection CPPEs/empyema. While empyema always requires drainage, the decision to drain a non-purulent PPE is based on the morphological (>1/2 hemithorax, loculations and thickening of the parietal pleura), bacteriological (culture) and biochemical characteristics (pH<7.20) of the PE.<a class="elsevierStyleCrossRefs" href="#bib0445">19,33</a> Lactate dehydrogenase (LDH)>1000IU/l and glucose<60mg/dl do not improve the diagnostic yield, and will only be used if the pH cannot be determined.<a class="elsevierStyleCrossRef" href="#bib0445">19</a> Factors such as air or traces of heparin or local anesthetic in the sample syringe can alter the pH results.<a class="elsevierStyleCrossRef" href="#bib0520">34</a> Furthermore, PIs caused by Proteus spp. can secrete enzymes that alkalize the PF.<a class="elsevierStyleCrossRef" href="#bib0525">35</a> Some patients with an initial pleural pH>7.20 may also require CD and even surgery. This is due to the heterogeneity of the biochemical characteristics in the loculated PE, since the degree of involvement of the aspirated chamber can significantly affect disease severity indices, as determined by pH. Therefore, although pleural pH is highly specific (91.8%)<a class="elsevierStyleCrossRef" href="#bib0530">36</a> in predicting the need for CD, it is less sensitive in determining mortality or the eventual need for surgery.<a class="elsevierStyleCrossRefs" href="#bib0370">4,19</a> While leading scientific societies accept this parameter for draining a PE,<a class="elsevierStyleCrossRefs" href="#bib0445">19,33</a> a retrospective analysis has shown that this test is not highly specific in establishing the need for CD in non-purulent PE, i.e. a group of patients with UPPE are considered as CPPE, which results in the needless placement of chest drains.<a class="elsevierStyleCrossRef" href="#bib0535">37</a> The total nucleated cell count and percentage of PMN leucocytes are usually higher in CPPE/empyemas.<a class="elsevierStyleCrossRef" href="#bib0540">38</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Alternative biomarkers in pleural fluidCRP has been used to differentiate both PPE from non-parapneumonic exudates,<a class="elsevierStyleCrossRefs" href="#bib0540">38–41</a> and UPPE from CPPE<a class="elsevierStyleCrossRefs" href="#bib0540">38,39</a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). It should be noted that the specificity of this test increases (96%<a class="elsevierStyleCrossRef" href="#bib0540">38</a> and 92%<a class="elsevierStyleCrossRef" href="#bib0550">40</a>) if high CRP values are combined with a predominance of PMNs in the PF. Moreover, if a CRP>100mg/l is accompanied by a pH<7.20 or glucose<60mg/dl, the specificity for the diagnosis of CPPE is 97%.<a class="elsevierStyleCrossRef" href="#bib0540">38</a><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Although procalcitonin (PCT) values are high in bacterial infections, the advantage of determining this peptide in PF and its capacity to differentiate CPPEs from UPPEs remains unclear.<a class="elsevierStyleCrossRefs" href="#bib0545">39–42</a> Nevertheless, a recent study confirmed that PCT is a specific biomarker for infection, and that PCT levels are not affected by non-infectious inflammation.<a class="elsevierStyleCrossRef" href="#bib0565">43</a> Furthermore, PCT differentiates PPE from non-infectious PPE better than CRP, although it does not predict the need for surgery or risk of death.<a class="elsevierStyleCrossRef" href="#bib0565">43</a>The diagnostic yield of other parameters such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-1β, IL-8, complement products (soluble form of C5b-9), neutrophil-derived enzymes (polymorphonuclear elastase and myeloperoxidase), lipopolysaccharide binding protein (LBP), and soluble receptor activator expressed in myeloid cells (sTREM-1), are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<a class="elsevierStyleCrossRefs" href="#bib0545">39,44–53</a> There is skepticism among investigators about the likelihood of a single parameter (especially without taking into account clinical, radiological or microbiological data) being capable of diagnosing PI with sufficient certainty to change current clinical practice.<a class="elsevierStyleCrossRef" href="#bib0620">54</a>TreatmentTreatment is based on controlling infection with appropriate antibiotics, draining the CPPE/empyema, assessing the use of fibrinolytics and existing surgical options, ensuring good nutrition, and administering anti-thrombotic prophylaxis.<a class="elsevierStyleCrossRef" href="#bib0625">55</a>AntibioticsThe use of antibiotics should be based on local microbiological recommendations and on the specific risks of each patient. Treatment should be initiated empirically and promptly, and adjusted to the community or nosocomial origin of the infection, culture results, and activity of the antibiotic in the PF.<a class="elsevierStyleCrossRef" href="#bib0630">56</a> In community-acquired PIs, the recommended combination is amoxicillin-clavulanic acid as monotherapy, or a third-generation cephalosporin and clindamycin/metronidazole. If the patient is allergic to penicillin, a quinolone can be combined with clindamycin/metronidazole. In nosocomial PIs, in which methicillin-resistant Staphylococcus aureus is very common,<a class="elsevierStyleCrossRef" href="#bib0450">20</a> the empirical regimen should cover this and anaerobic microorganisms (e.g. vancomycin/linezolid, anti-Pseudomonas penicillins, carbapenem or third-generation cephalosporins combined with metronidazole). Macrolides are not generally used, since although pneumonia caused by Legionella or Mycoplasma pneumoniae can present with PE, it is usually self-limiting and rarely causes empyema.<a class="elsevierStyleCrossRef" href="#bib0635">57</a> The use of aminoglycosides is not recommended, due to their poor penetration in the pleural space, nor is there evidence to recommend the intra-pleural use of antibiotics.<a class="elsevierStyleCrossRef" href="#bib0430">16</a>Chest drainageAlthough there is no consensus on the caliber of the drainage tube, British Thoracic Society<a class="elsevierStyleCrossRef" href="#bib0445">19</a> guidelines and other studies<a class="elsevierStyleCrossRef" href="#bib0640">58</a> suggest that small bore tubes (10–14F) are suitable for most CPPEs, as they are easier to place, are less traumatic and painful for the patient, and are as effective as larger bore tubes (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Insertion of a chest catheter should always be image-guided, generally using CU. It is indicated in patients with cloudy or purulent PF, positive PF staining or culture, loculation or PE greater than half the hemithorax, pH<7.20, or thickening of the parietal pleura.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>FibrinolyticsThere are no indications in current guidelines for the routine use of intrapleural fibrinolytics in patients with PI,<a class="elsevierStyleCrossRef" href="#bib0445">19</a> and their systematic use in the management of CPPE is controversial.<a class="elsevierStyleCrossRef" href="#bib0645">59</a> A Cochrane review confirmed that intrapleural fibrinolytics are beneficial in both reducing treatment failure and the need for surgery in loculated PEs or empyema, although they do not affect mortality.<a class="elsevierStyleCrossRef" href="#bib0650">60</a> In patients who received alteplase (a tissue plasminogen activator) and deoxyribonuclease (DNase), pleural opacity on radiography, need for surgery at 3 months, and mean hospital stay were significantly improved compared to placebo.<a class="elsevierStyleCrossRef" href="#bib0655">61</a> A meta-analysis that included this study (and others using streptokinase and urokinase) showed heterogeneous results, but suggested that treatment with fibrinolytics reduces the need for surgery, but not the risk of mortality (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<a class="elsevierStyleCrossRefs" href="#bib0365">3,61–67</a> Current guidelines recommend the prompt use of fibrinolytics when there are loculations in the pleural cavity (resistant to CD) and in empyema. There is insufficient evidence to recommend one drug over another, and no consensus on the recommended dose.<a class="elsevierStyleCrossRefs" href="#bib0445">19,55</a> Guidelines also recommend closing the CD tube for a few hours after fibrinolytic administration.<a class="elsevierStyleCrossRefs" href="#bib0445">19,61</a><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>SurgerySurgery (video-assisted thoracoscopic surgery [VATS] drainage; thoracotomy with pleural decortication, or other type of open surgical drainage) must be considered when medical treatment (antibiotics, CD and fibrinolytics) fails after 5–7 days,<a class="elsevierStyleCrossRefs" href="#bib0430">16,19,55</a> or when organized empyema is established and there is evidence of significant pleural fibrosis. The early finding of purulent PF or loculations is not predictive of surgery.<a class="elsevierStyleCrossRef" href="#bib0360">2</a> In addition to pleural debridement, VATS facilitates decortication in advanced or chronic empyema. In the latter, the outcomes are poorer, as the highest success rates are obtained when the procedure is performed at an early stage. Nevertheless, the overall success rate of this technique exceeds 85%.<a class="elsevierStyleCrossRef" href="#bib0690">68</a> Several studies have compared conservative treatment (antibiotics and CD with/without fibrinolytics) with VATS as first line treatment in both children and adults. Early surgery has not shown any advantages in mortality or severe morbidity in any trials.<a class="elsevierStyleCrossRef" href="#bib0695">69</a> Moreover, surgery is not free from complications, particularly post-surgical pleural intercostal neuralgia. Decortication by thoracotomy in empyema is being increasingly replaced by VATS, in light of evidence that the latter is at least comparable, or even better,<a class="elsevierStyleCrossRef" href="#bib0700">70</a> and is usually reserved for cases in which less invasive procedures have failed.NutritionPoor nutrition is an adverse determinant in pleural empyema outcome, although this factor is not generally taken into account. PIs associated with hypoalbuminemia have a worse outcome,<a class="elsevierStyleCrossRefs" href="#bib0430">16,19,55</a> and patients should be given adequate nutritional support, including complementary enteral feeding, as soon as diagnosis is confirmed.Anti-thrombotic prophylaxisAll patients hospitalized for pneumonia and/or PI should receive prophylaxis with low molecular weight heparins, if these are not contraindicated.<a class="elsevierStyleCrossRefs" href="#bib0430">16,19,55</a>ConclusionsThe incidence of PPE is increasing worldwide, across all age groups. Although related with pneumonia, there is little correlation between organisms found in the pleural space and those observed in lung parenchyma infections, suggesting that primary PI is more common than previously thought. Current diagnostic methods focus on being able to predict whether a PPE will progress to a CPPE/empyema. Diagnosis and early strategies such as antibiotic regimens and CT continue to form the basis of treatment. In a sub-group of patients, fibrinolytics help to improve recovery, and have been associated with better outcome when combined with DNase. If surgery is necessary, there is increasing evidence that VATS is comparable to, if not better than, decortication by thoracotomy, and so should be reserved for cases in which less invasive procedures have failed (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Further clinical trials are needed to define evidence-based diagnostic and therapeutic strategies that provide more effective, standardized management of this disease.<elsevierMultimedia ident="fig0020"></elsevierMultimedia>Authors’ contributionsFerreiro L. and Valdés L. are the authors and editors and also contributed in conception, design and final approval of the manuscript. San José ME is the co-author and editor. He helped in final approval of the manuscript.Conflict of interestThe authors declare that they have no conflict of interests." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres587071" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec602847" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec602849" "titulo" => "Abreviaturas" ] 3 => array:3 [ "identificador" => "xres587072" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec602848" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:2 [ "identificador" => "sec0010" "titulo" => "Epidemiology" ] 7 => array:2 [ "identificador" => "sec0015" "titulo" => "Physiopathology" ] 8 => array:3 [ "identificador" => "sec0020" "titulo" => "Diagnosis" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Pneumonia severity scales and scores" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Imaging tests" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Microbiology" ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "Pleural fluid analysis" ] 4 => array:2 [ "identificador" => "sec0045" "titulo" => "Alternative biomarkers in pleural fluid" ] ] ] 9 => array:3 [ "identificador" => "sec0050" "titulo" => "Treatment" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Antibiotics" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Chest drainage" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Fibrinolytics" ] 3 => array:2 [ "identificador" => "sec0070" "titulo" => "Surgery" ] 4 => array:2 [ "identificador" => "sec0075" "titulo" => "Nutrition" ] 5 => array:2 [ "identificador" => "sec0080" "titulo" => "Anti-thrombotic prophylaxis" ] ] ] 10 => array:2 [ "identificador" => "sec0085" "titulo" => "Conclusions" ] 11 => array:2 [ "identificador" => "sec0090" "titulo" => "Authors’ contributions" ] 12 => array:2 [ "identificador" => "sec0095" "titulo" => "Conflict of interest" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-11-24" "fechaAceptado" => "2015-01-16" "PalabrasClave" => array:2 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec602847" "palabras" => array:8 [ 0 => "Parapneumonic pleural effusion" 1 => "Complicated parapneumonic pleural effusion" 2 => "Empyema" 3 => "Chest drainage" 4 => "Pleural fluid analysis" 5 => "Culture of pleural fluid" 6 => "Intrapleural fibrinolytics" 7 => "Thoracoscopy" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec602849" "palabras" => array:2 [ 0 => "AUC" 1 => "IL" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec602848" "palabras" => array:8 [ 0 => "Derrame pleural paraneumónico" 1 => "Derrame pleural paraneumónico complicado" 2 => "Empiema" 3 => "Drenaje torácico" 4 => "Análisis del líquido pleural" 5 => "Cultivo del líquido pleural" 6 => "Fibrinolíticos intrapleurales" 7 => "Toracoscopia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Pleural infections have high morbidity and mortality, and their incidence in all age groups is growing worldwide. Not all infectious effusions are parapneumonic and, in such cases, the organisms found in the pleural space are not the same as those observed in lung parenchyma infections. The diagnostic difficulty lies in knowing whether an infectious effusion will evolve into a complicated effusion/empyema, as the diagnostic methods used for this purpose provide poor results.The mainstays of treatment are to establish an early diagnosis and to commence an antibiotic regimen and chest drain as soon as possible. This should preferably be carried out with fine tubes, due to certain morphological, bacteriological and biochemical characteristics of the pleural fluid. Fluid analysis, particularly pH, is the most reliable method for assessing evolution. In a subgroup of patients, fibrinolytics may help to improve recovery, and their combination with DNase has been found to obtain better results. If medical treatment fails and surgery is required, video-assisted thoracoscopic surgery (VATS) is, at least, comparable to decortication by thoracotomy, so should only undertaken if previous techniques have failed.Further clinical trials are needed to analyze factors that could affect the results obtained, in order to define new evidence-based diagnostic and therapeutic strategies that provide more effective, standardized management of this disease." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Las infecciones pleurales presentan una elevada morbimortalidad, y su incidencia está aumentando en todos los países del mundo y en todos los grupos de edad. No todos los derrames infecciosos son paraneumónicos, y en esos casos, los organismos que se encuentran en el espacio pleural no son los mismos que se observan en las infecciones del parénquima pulmonar. La dificultad diagnóstica radica en saber si un derrame infeccioso evolucionará hacia un derrame complicado/empiema, ya que los métodos diagnósticos utilizados con este fin ofrecen pobres resultados.Los pilares del tratamiento son establecer un diagnóstico precoz e instaurar, lo antes posible, una pauta antibiótica y un drenaje torácico. Este se llevará a cabo, preferiblemente con tubos de pequeño calibre, ante la presencia de determinadas características morfológicas, bacteriológicas y bioquímicas del líquido pleural. El análisis del líquido es el método más fiable para valorar su evolución, sobre todo la determinación del pH. En un subgrupo de pacientes los fibrinolíticos pueden contribuir a mejorar la recuperación, y su combinación con deoxirribonucleasa se relaciona con la obtención de mejores resultados. Si fracasa el tratamiento médico y es necesaria la cirugía, la rentabilidad de la cirugía toracoscópica videoasistida es, al menos, comparable a la decorticación por toracotomía, por lo que esta solamente se realizará si han fallado las técnicas anteriores.Son necesarios más ensayos clínicos que analicen factores que puedan influir sobre los resultados obtenidos para conformar nuevas estrategias diagnósticas y terapéuticas basadas en la evidencia, que proporcionen un manejo más efectivo y estandarizado de esta enfermedad." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Ferreiro L, San José ME, Valdés L. Manejo del derrame pleural paraneumónico en adultos. Arch Bronconeumol. 2015;51:637–646." ] ] "multimedia" => array:8 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from Bhatnagar and Maskell.<a class="elsevierStyleCrossRef" href="#bib0430">16</a>" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2661 "Ancho" => 4167 "Tamanyo" => 500173 ] ] "descripcion" => array:1 [ "en" => "Physiopathology, appearance, biochemical parameters and microbiology of parapneumonic pleural effusion." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1819 "Ancho" => 2903 "Tamanyo" => 428709 ] ] "descripcion" => array:1 [ "en" => "(A) Anechoic pleural effusion. (B) Pleural effusion with multiple septa and loculations. L, loculation; PF, pleural fluid; S, septum." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1683 "Ancho" => 3170 "Tamanyo" => 219604 ] ] "descripcion" => array:1 [ "en" => "Microbiology of community- and hospital-acquired pleural infection.<a class="elsevierStyleCrossRef" href="#bib0450">20</a> MRSA, Methicillin-resistant Staphylococcus aureus." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2125 "Ancho" => 3210 "Tamanyo" => 339062 ] ] "descripcion" => array:1 [ "en" => "Treatment algorithm for parapneumonic pleural effusion. CD, chest drainage; CT, computed tomography; CU, chest ultrasound; G, generation; MR, medical record; PE, pleural effusion; PEx physical examination; PF, pleural fluid; PPE, parapneumonic pleural effusion. 1 If allergic to penicillin: quinolone+metronidazole. 2 If the pH cannot be determined, use LDH>1000IU/l or glucose<60mg/dl." ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "ADA, adenosine deaminase; CPPE, complicated parapneumonic pleural effusion; CRP, C-reactive protein; LDH, lactate dehydrogenase; PF, pleural fluid; PPE, parapneumonic pleural effusion." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tests \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics of CPPE/empyema \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">pH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Likely if < 7.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Should be measured on a blood gas analyzerLow values if acidosis in the pleural space \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glucose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Likely if < 60mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Due to the increase in cell metabolism \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LDH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Likely if > 1000IU/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Measure in PF and bloodDue to cell destruction \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total protein \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>3g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Measure in PF and blood \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total and percentage nucleated cell count \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">High total count with predominance of polymorphonuclear cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Highly scattered values, as it depends on involvement of the aspirated pleural chamber.If previously treated with antibiotics, the predominant cell type could be lymphocytic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">CRP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Likely if >100mg/l and accompanied by a pH<7.20 or glucose<60mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">High specificity for diagnosis of PPE if associated with predominantly polymorphonuclear cells \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PF culture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">May be positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Higher diagnostic yield if collected in blood culture bottles \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PF cytology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Changes similar to those in PPE occasionally observed in the fluid of malignant effusions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">ADA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">May be elevatedPredominance of polymorphonuclear cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To be determined if tuberculosis is suspected; in this case, predominantly lymphocytic \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab958621.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Pleural fluid testing when an infectious pleural effusion is suspected." ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "AUC, area under the curve; CPPE, complicated parapneumonic pleural effusion; CRP, C-reactive protein; IL, interleukin; LBP, lipopolysaccharide-binding proteins; PPE, parapneumonic pleural effusion; Ref, reference; SC5b-9, soluble form of C5b-9; Se, sensitivity; Sp, specificity; sTREM-1, soluble triggering receptor expressed on myeloid cells-1; TNF-α, tumor necrosis factor alpha; UPPE, uncomplicated parapneumonic pleural effusion." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Parameter \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PPE versus other effusions</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">UPPE versus CPPE/empyema</th><th class="td" title="table-head " align="left" valign="top" scope="col">Ref \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cut-off point \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AUC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Se (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cut-off point \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AUC \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Se (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">CRP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>45mg/l>80mg/l>3.7mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.820.830.750.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75497354 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75937377 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>100mg/l>80mg/>80mg/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.810.810.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">586872 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">887571 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0540">38</a><a class="elsevierStyleCrossRef" href="#bib0545">39</a><a class="elsevierStyleCrossRef" href="#bib0550">40</a><a class="elsevierStyleCrossRef" href="#bib0560">42</a><a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a><a class="elsevierStyleCrossRef" href="#bib0595">49</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Procalcitonin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>0.25ng/ml>0.14ng/ml0.18ng/ml0.19ng/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.570.590.750.830.710.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">455267766765 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">726777817068 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>0.5ng/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0545">39</a><a class="elsevierStyleCrossRef" href="#bib0550">40</a><a class="elsevierStyleCrossRef" href="#bib0555">41</a><a class="elsevierStyleCrossRef" href="#bib0555">41</a><a class="elsevierStyleCrossRef" href="#tblfn0005">a</a><a class="elsevierStyleCrossRef" href="#bib0560">42</a><a class="elsevierStyleCrossRef" href="#tblfn0010">b</a><a class="elsevierStyleCrossRef" href="#bib0560">42</a><a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">TNF-α \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>80pg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0570">44</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">IL-6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>77.3pg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.704 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0580">46</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">IL-1β \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>16.7pg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0600">50</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">IL-8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>1000pg/ml>2130pg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.870.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8473 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8290 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0595">49</a><a class="elsevierStyleCrossRef" href="#bib0600">50</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">SC5b-9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>2000μg/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0605">51</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Polymorphonuclear elastase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>3500μg/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0610">52</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Myeloperoxidase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>3000μg/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0615">53</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LLP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>17μg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>17μg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0545">39</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">sTREM-1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>80pg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>180pg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0545">39</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab958619.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "In blood." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Meta-analysis." ] ] ] "descripcion" => array:1 [ "en" => "Diagnostic yield of alternative biomarkers in pleural fluid for the diagnosis of parapneumonic pleural effusions." ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from Rahman et al.<a class="elsevierStyleCrossRef" href="#bib0640">58</a>" "tabla" => array:2 [ "leyenda" => "F, French; IQR, interquartile range; PE, pleural effusion; PF, pleural fluid; SD, standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Caliber of tube, F</th><th class="td" title="table-head " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><10 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">10–14 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">15–20 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">>20 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Patients (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">208 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Sex, n (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 (71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">144 (69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 (69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 (62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 (31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Opacification chest X-ray due to PE (% of hemithorax) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Characteristics PF</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Purulence, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42 (72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">164 (79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58 (83) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65 (94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gram positive for bacteria, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">87 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 (43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 (41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Culture positive for bacteria, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">78 (38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.49 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">pH, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.89 (0.29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.87 (0.41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.82 (0.44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.64 (0.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Glucose (mmol/l), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.1 (2.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.3 (4.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.2 (2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.3 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LDH (IU/l), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.580 (34.700) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.820 (22.280) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20.400 (28.300) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.580 (37.550) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Source of infection, n (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.73 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Community \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 (82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">163 (78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52 (74) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53 (77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.73 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Combination of surgery and death, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21/58 (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75/208 (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28/70 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30/69 (44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Death at 1 year, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10/58 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46/208 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18/70 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17/69 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Surgery at 1 year, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/58 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35/208 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13/70 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13/69 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hospital stay, days (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FEV1at 3 months, L (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.46 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.16 (0.79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.30 (0.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.15 (0.90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FVC at 3 months, l (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.30 (1.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.98 (0.98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.18 (1.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.84 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Reduction in chest X-ray abnormality with respect to baseline at 3 months, median % hemithorax (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 (77–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 (77–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 (52–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 (77–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.40 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab958620.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient characteristics according to the size of the chest-tube caliber and the effect of the caliber on primary and secondary clinical outcomes." ] ] 7 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from Janda and Swiston.<a class="elsevierStyleCrossRef" href="#bib0660">62</a>" "tabla" => array:3 [ "leyenda" => "CPPE, complicated parapneumonic pleural effusion; CT, computed tomography; CU, chest ultrasound; E, empyema; F, French; N.S., not significant; Pbo, placebo group; PPE, parapneumonic pleural effusion; Tx, treatment group." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Reference \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Country \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Patients included \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Types of PPE included \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Image<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Size drainage tube \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Treatment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mortality (%)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery rate (%)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tx \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pbo \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tx \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pbo \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Maskell et al.<a class="elsevierStyleCrossRef" href="#bib0365">3</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">United Kingdom \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">454 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CPPE & E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X-ray \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12–20F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Streptokinase: 250,000IU; 1 dose/12h/3 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N.S. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N.S. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Rahman et al.<a class="elsevierStyleCrossRef" href="#bib0655">61</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">United Kingdom \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">210 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CPPE & E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X-ray \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><15F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">t-PA & DNase: 10mg+5mg; 1 dose/12h/3 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N.S. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p=0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Davies et al.<a class="elsevierStyleCrossRef" href="#bib0665">63</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">United Kingdom \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CPPE & E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X-ray, CU, CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Streptokinase: 250,000IU; 1 dose/24h/3 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N.S. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not given \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Bouros et al.<a class="elsevierStyleCrossRef" href="#bib0670">64</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Greece \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CPPE & E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CU, CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28–32F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Urokinase: 100,000IU; 1 dose/24h/3 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N.S. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Tuncozgur et al.<a class="elsevierStyleCrossRef" href="#bib0675">65</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Turkey \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E stage II<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X-ray, CU, CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24–36F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Urokinase: 100,000IU; 1 dose/24h/3 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N.S. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diacon et al.<a class="elsevierStyleCrossRef" href="#bib0680">66</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">South Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CPPE & E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X-ray, CU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24–28F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Streptokinase: 250,000IU; 1 dose/24h/7 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N.S. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Misthos et al.<a class="elsevierStyleCrossRef" href="#bib0685">67</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Greece \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">127 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X-ray, CU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28–32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Streptokinase: 250,000IU; 1 dose/24h/3 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">p<0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab958622.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "Imaging modality used to evaluate the effusions." ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "Defined by the American Thoracic Society." ] ] ] "descripcion" => array:1 [ "en" => "Intrapleural fibrinolytic treatment. Characteristics of the placebo-controlled trials." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:70 [ 0 => array:3 [ "identificador" => "bib0355" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parapneumonic effusions and empyema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.W. Light" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Pleural diseases" "paginaInicial" => "179" "paginaFinal" => "210" "serieFecha" => "2007" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0360" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "U.K. controlled trial of intrapleural streptokinase for pleural infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.A. Maskell" 1 => "C.W.H. Davies" 2 => "A.J. Nunn" 3 => "E.L. Hedley" 4 => "F.V. Gleeson" 5 => "R. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa042473" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2005" "volumen" => "352" "paginaInicial" => "865" "paginaFinal" => "874" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15745977" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0365" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic features of residual pleural thickening in parapneumonic pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Jiménez-Castro" 1 => "G. Díaz" 2 => "E. Pérez-Rodriguez" 3 => "R.W. Light" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2003" "volumen" => "21" "paginaInicial" => "952" "paginaFinal" => "955" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12797487" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0370" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of outcome and long-term survival in patients with pleural infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.W. Davies" 1 => "S.E. Kearney" 2 => "F.V. Gleeson" 3 => "R.J. Davies" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.160.5.9903002" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1999" "volumen" => "160" "paginaInicial" => "1682" "paginaFinal" => "1687" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10556140" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0375" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Empyema: an increasing concern in Canada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Finley" 1 => "J. Clifton" 2 => "J.M. Fitzgerald" 3 => "J. Yee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can Respir J" "fecha" => "2008" "volumen" => "15" "paginaInicial" => "85" "paginaFinal" => "89" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18354748" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0380" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical course and management of thoracic empyema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.D. Ferguson" 1 => "R.J. Prescott" 2 => "J.B. Selkon" 3 => "D. Watson" 4 => "C.R. Swinburn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "QJM" "fecha" => "1996" "volumen" => "89" "paginaInicial" => "285" "paginaFinal" => "289" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8733515" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0385" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of parapneumonic effusions and empyema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.A. Sahn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/522996" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2007" "volumen" => "45" "paginaInicial" => "1480" "paginaFinal" => "1486" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17990232" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0390" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of pleural space infections: a population-based analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Farjah" 1 => "R. Symons" 2 => "B. Krishnadasan" 3 => "D.E. Wood" 4 => "D.R. Flum" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2006.09.038" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2007" "volumen" => "133" "paginaInicial" => "346" "paginaFinal" => "351" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17258562" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0395" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Li" 1 => "D. Tancredi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2009-0184" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2010" "volumen" => "125" "paginaInicial" => "26" "paginaFinal" => "33" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19948570" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0400" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complicated community acquired pneumonia in children prior to the introduction of the pneumococcal conjugate vaccine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Goldbart" 1 => "E. Leibovitz" 2 => "N. Porat" 3 => "N. Givon-Lavi" 4 => "I. Drukmann" 5 => "A. Tal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00365540802688378" "Revista" => array:6 [ "tituloSerie" => "Scand J Infect Dis" "fecha" => "2009" "volumen" => "41" "paginaInicial" => "182" "paginaFinal" => "187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19117244" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0405" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of hospitalized children with pneumococcal/lobar pneumonia and empyema from 1997 to 2004 in Taiwan" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.S. Wu" 1 => "L.M. Huang" 2 => "I.S. Chang" 3 => "C.Y. Lu" 4 => "P.L. Shao" 5 => "F.Y. Tsai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Paediatr" "fecha" => "2010" "volumen" => "169" "paginaInicial" => "861" "paginaFinal" => "866" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0410" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emergence of parapneumonic empyema in the USA" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.G. Grijalva" 1 => "Y. Zhu" 2 => "J.P. Nuorti" 3 => "M.R. Griffin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2010.156406" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2011" "volumen" => "66" "paginaInicial" => "663" "paginaFinal" => "668" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21617169" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0415" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural fluid tests to identify complicated parapneumonic effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. Porcel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCP.0b013e328338a108" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Pulm Med" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "357" "paginaFinal" => "361" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20224408" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0420" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The pathogenesis of pleural space loculation and fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Idell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCP.0b013e3282fd0d9b" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Pulm Med" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "310" "paginaFinal" => "315" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18520264" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0425" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single-chain urokinase alone or complexed to its receptor in tetracycline-induced pleuritis in rabbits" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Idell" 1 => "A. Mazar" 2 => "D. Cines" 3 => "A. Kuo" 4 => "G. Parry" 5 => "S. Gawlak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200204-313OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2002" "volumen" => "166" "paginaInicial" => "920" "paginaFinal" => "926" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12359647" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0430" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of complicated pleural effusions in 2013" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Bhatnagar" 1 => "N.A. Maskell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccm.2012.11.004" "Revista" => array:6 [ "tituloSerie" => "Clin Chest Med" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "47" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23411056" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0435" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parapneumonic effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.W. Light" 1 => "W.M. Girard" 2 => "S.G. Jenkinson" 3 => "R.B. George" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "1980" "volumen" => "69" "paginaInicial" => "507" "paginaFinal" => "512" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7424940" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0440" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "BTS guidelines for the management of community acquired pneumonia in adults: update 2009" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.S. Lim" 1 => "S.V. Baudouin" 2 => "R.C. George" 3 => "A.T. Hill" 4 => "C. Jamieson" 5 => "I. Le Jeune" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2009.113506" "Revista" => array:5 [ "tituloSerie" => "Thorax" "fecha" => "2009" "volumen" => "64" "numero" => "Suppl. 3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19717706" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0445" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "on behalf of the BTS Pleural Disease Guideline Group" "etal" => false "autores" => array:3 [ 0 => "H.E. Davies" 1 => "R.J.O. Davies" 2 => "C.W.H. Davies" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Thorax" "fecha" => "2010" "volumen" => "65" "numero" => "Suppl. 2" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0450" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The bacteriology of pleural infection by genetic and standard methods and its mortality significance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N.A. Maskell" 1 => "S. Batt" 2 => "E.L. Hedley" 3 => "C.W. Davies" 4 => "S.H. Gillespie" 5 => "R.J. Davies" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200601-074OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2006" "volumen" => "174" "paginaInicial" => "817" "paginaFinal" => "823" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16840746" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0455" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prediction rule to identify low-risk patients with community-acquired pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Fine" 1 => "T.E. Auble" 2 => "D.M. Yealy" 3 => "B.H. Hanusa" 4 => "L.A. Weissfeld" 5 => "D.E. Singer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199701233360402" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1997" "volumen" => "336" "paginaInicial" => "243" "paginaFinal" => "250" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8995086" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0460" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.D. Chalmers" 1 => "A. Singanayagam" 2 => "M.P. Murray" 3 => "C. Scally" 4 => "A. Fawzi" 5 => "A.T. Hill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2008.105080" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2009" "volumen" => "64" "paginaInicial" => "592" "paginaFinal" => "597" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19131449" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0465" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A clinical socre (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N.M. Rahman" 1 => "B.C. Kahan" 2 => "R.F. Miller" 3 => "F.V. Gleeson" 4 => "A.J. Nunn" 5 => "N.A. Maskell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.13-1558" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2014" "volumen" => "145" "paginaInicial" => "848" "paginaFinal" => "855" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24264558" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0470" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic utility and clinical application of imaging for pleural space infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.E. Heffner" 1 => "J.S. Klein" 2 => "C. Hampson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.08-3002" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "137" "paginaInicial" => "467" "paginaFinal" => "479" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20133295" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0475" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differentiating lung abscess and empiema: radiography and computed tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.D. Stark" 1 => "M.P. Federle" 2 => "P.C. Goodman" 3 => "A.E. Podrasky" 4 => "W.R. Webb" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "1983" "volumen" => "141" "paginaInicial" => "163" "paginaFinal" => "167" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0480" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The definition and epidemiology of pleural space infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Strange" 1 => "S.A. Sahn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Semin Respir Infect" "fecha" => "1999" "volumen" => "14" "paginaInicial" => "3" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10197392" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0485" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus (the Streptococcus milleri group): association with different body sites and clinical infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.A. Whiley" 1 => "D. Beighton" 2 => "T.G. Winstanley" 3 => "H.Y. Fraser" 4 => "J.M. Hardie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "1992" "volumen" => "30" "paginaInicial" => "243" "paginaFinal" => "244" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1734062" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0490" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural infection: changing bacteriology and its implications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Lisboa" 1 => "G.W. Waterer" 2 => "Y.C. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1843.2011.01964.x" "Revista" => array:6 [ "tituloSerie" => "Respirology" "fecha" => "2011" "volumen" => "16" "paginaInicial" => "598" "paginaFinal" => "603" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21382129" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0495" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parapneumonic pleural effusion incidence in a French region before and during the antipneumococcal vaccine era" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Masson" 1 => "C. Menetrey" 2 => "F. Garnier" 3 => "C. Bahans" 4 => "A. Fargeot" 5 => "M. Layadi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arcped.2011.05.010" "Revista" => array:6 [ "tituloSerie" => "Arch Pediatr" "fecha" => "2011" "volumen" => "18" "paginaInicial" => "846" "paginaFinal" => "849" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21664805" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0500" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventional management of pleural infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.E. Heffner" 1 => "J.S. Klein" 2 => "C. Hampson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.08-2956" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2009" "volumen" => "136" "paginaInicial" => "1148" "paginaFinal" => "1159" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19809058" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0505" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What size parapneumonic effusions should be sampled?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Skouras" 1 => "A. Awdankiewicz" 2 => "R.W. Light" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2008.112797" "Revista" => array:5 [ "tituloSerie" => "Thorax" "fecha" => "2010" "volumen" => "65" "paginaInicial" => "91" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20029043" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0510" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Existe una pleuritis paraneumónica decapitada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Cobas-Paz" 1 => "M. Botana-Rial" 2 => "A. Fernández-Villar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2009.11.014" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2010" "volumen" => "46" "paginaInicial" => "282" "paginaFinal" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20092932" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0515" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical and surgical treatment of parapneumonic effusions. An evidence-based guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.L. Colice" 1 => "A. Curtis" 2 => "J. Deslauriers" 3 => "J. Heffner" 4 => "R. Light" 5 => "B. Littenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2000" "volumen" => "118" "paginaInicial" => "1158" "paginaFinal" => "1171" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11035692" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0520" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinically important factors influencing the diagnostic measurement of pleural fluid pH and glucose" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N.M. Rahman" 1 => "E.K. Mishra" 2 => "H.E. Davies" 3 => "R.J. Davies" 4 => "Y.C. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200801-062OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2008" "volumen" => "178" "paginaInicial" => "483" "paginaFinal" => "490" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18556632" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0525" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Elevated pleural fluid pH in Proteus mirabilis empyema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.R. Pine" 1 => "J.L. Hollman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1983" "volumen" => "84" "paginaInicial" => "109" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6345098" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0530" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural fluid parameters identifying complicated parapneumonic effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Jiménez-Castro" 1 => "G. Díaz-Nuevo" 2 => "A. Sueiro" 3 => "A. Muriel" 4 => "E. Pérez-Rodríguez" 5 => "R.W. Light" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000086248" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2005" "volumen" => "72" "paginaInicial" => "357" "paginaFinal" => "364" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16088277" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0535" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of the British Thoracic Society and the American College of Chest Physicians guidelines in predicting pleural drainage of non-purulent parapneumonic effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.M. Porcel" 1 => "M. Vives" 2 => "A. Esquerda" 3 => "A. Ruiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2005.06.017" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2006" "volumen" => "100" "paginaInicial" => "933" "paginaFinal" => "937" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16253494" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0540" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural fluid C-reactive protein contributes to the diagnosis and assessment of severity of parapneumonic effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.M. Porcel" 1 => "S. Bielsa" 2 => "A. Esquerda" 3 => "A. Ruiz-González" 4 => "M. Falguera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejim.2012.03.002" "Revista" => array:6 [ "tituloSerie" => "Eur J Intern Med" "fecha" => "2012" "volumen" => "23" "paginaInicial" => "447" "paginaFinal" => "450" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22726374" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0545" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biomarkers of infection for the differential diagnosis of pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Porcel" 1 => "M. Vives" 2 => "G. Cao" 3 => "S. Bielsa" 4 => "A. Ruiz-González" 5 => "A. Martínez-Iribarren" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00197208" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "1383" "paginaFinal" => "1389" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19541708" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0550" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Procalcitonin, C-reactive protein, and cell counts in the diagnosis of parapneumonic pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.E. San José" 1 => "L. Valdés" 2 => "L.H. Vizcaíno" 3 => "T. Mora" 4 => "A. Pose" 5 => "E. Soneira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.231/JIM.0b013e3181f88648" "Revista" => array:6 [ "tituloSerie" => "J Investig Med" "fecha" => "2010" "volumen" => "58" "paginaInicial" => "971" "paginaFinal" => "976" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20930646" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0555" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic and prognostic values of pleural fluid procalcitonin in parapneumonic pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.C. Lin" 1 => "Y.C. Chen" 2 => "J.T. Wu" 3 => "Y.C. Ko" 4 => "C.C. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.08-1134" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2009" "volumen" => "136" "paginaInicial" => "205" "paginaFinal" => "211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19255287" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0560" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of pleural fluid procalcitonin and C-reactive protein in the diagnosis of parapneumonic pleural effusions: a systemic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Z. Ming-Xiang" 1 => "Z. Rong-Rong" 2 => "W. Wen-Ju" 3 => "Z. Ning-Jie" 4 => "L. Wen-En" 5 => "F. Xue-Gong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajem.2012.04.004" "Revista" => array:6 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "1907" "paginaFinal" => "1914" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22795416" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0565" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ability of procalcitonin to discriminate infection from non-infective inflammation using two pleural disease settings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.J. McCann" 1 => "S.J. Chapman" 2 => "W.C. Yu" 3 => "N.A. Maskell" 4 => "R.J. Davies" 5 => "Y.C. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0049894" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "e49894" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23251353" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0570" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor necrosis factor-α in pleural fluid. A marker of complicated parapneumonic effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Porcel" 1 => "M. Vives" 2 => "A. Esquerda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2004" "volumen" => "125" "paginaInicial" => "160" "paginaFinal" => "164" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14718436" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0575" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural fluid interferon-γ and tumour necrosis factor-α in tuberculous and rheumatoid pleurisy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Soderblom" 1 => "P. Nyberg" 2 => "A.M. Teppo" 3 => "M. Klockars" 4 => "H. Riska" 5 => "T. Pettersson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "1996" "volumen" => "9" "paginaInicial" => "1652" "paginaFinal" => "1655" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0580" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic value of proinflammatory interleukins in parapneumonic effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1309/AJCPB67PYKVRVPPR" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Pathol" "fecha" => "2010" "volumen" => "133" "paginaInicial" => "884" "paginaFinal" => "891" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0585" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Discrimination of exudative pleural effusions based on multiple biological parameters" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00126306" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2007" "volumen" => "30" "paginaInicial" => "957" "paginaFinal" => "964" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0590" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumour necrosis factor-a and nitric oxide, determined as nitrite, in malignant pleural effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "1994" "volumen" => "88" "paginaInicial" => "743" "paginaFinal" => "748" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0595" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural fluid interleukin-8 and C-reactive protein for discriminating complicated nonpurulent from uncomplicated parapenumonic effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1843.2007.01189.x" "Revista" => array:6 [ "tituloSerie" => "Respirology" "fecha" => "2008" "volumen" => "13" "paginaInicial" => "58" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0600" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utility of measurement of interleukin-1β and interleukin-8 in the diagnosis of complicated parapneumonic pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1309/AJCPDC7PS8TIPBXP" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Pathol" "fecha" => "2014" "volumen" => "142" "paginaInicial" => "467" "paginaFinal" => "473" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0605" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural SC5b-9: a test for identifying complicated parapneumonic effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "29543" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2000" "volumen" => "67" "paginaInicial" => "433" "paginaFinal" => "438" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0610" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymorphonuclear elastase in the early diagnosis of complicated pyogenic pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "74200" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2003" "volumen" => "70" "paginaInicial" => "462" "paginaFinal" => "467" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0615" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural-fluid myeloperoxidase in complicated and noncomplicated parapneumonic effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2002" "volumen" => "19" "paginaInicial" => "320" "paginaFinal" => "325" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0620" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural infection: what we need to know but don’t" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCP.0b013e328352c673" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Pulm Med" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "321" "paginaFinal" => "325" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0625" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normativa sobre el diagnóstico y tratamiento del derrame pleural. Actualización" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2014.01.016" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2014" "volumen" => "50" "paginaInicial" => "235" "paginaFinal" => "249" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0630" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antibiotic levels in empyemic pleural fluid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2000" "volumen" => "117" "paginaInicial" => "1734" "paginaFinal" => "1739" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0635" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinicoradiographic correlation with the extent of Legionnaire disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "1983" "volumen" => "141" "paginaInicial" => "263" "paginaFinal" => "268" ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0640" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relationship between chest tube size and clinical outcome in pleural infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.09-1044" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "137" "paginaInicial" => "536" "paginaFinal" => "543" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0645" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point: should fibrinolytics be routinely administered intrapleurally for management of a complicated parapneumonic effusion? Yes/No" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.13-2354" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2014" "volumen" => "145" "paginaInicial" => "14" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0650" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2008" ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0655" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intrapleural use of tissue plasminogen activator and DNase in pleural infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1012740" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "365" "paginaInicial" => "518" "paginaFinal" => "526" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0660" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intra-pleural fibrinolytic therapy for treatment of adult parapneumonic effusions and empyemas: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.11-3071" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2012" "volumen" => "142" "paginaInicial" => "401" "paginaFinal" => "411" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib0665" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomised controlled trial of intrapleural streptokinase in community acquired pleural infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "1997" "volumen" => "52" "paginaInicial" => "416" "paginaFinal" => "421" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0670" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intrapleural urokinase versus normal saline in the treatment of complicated parapneumonic effusions and empyema. A randomized, double-blind study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.159.1.9803094" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1999" "volumen" => "159" "paginaInicial" => "37" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib0675" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intrapleural urokinase in the management of parapneumonic empyema: a randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Clin Pract" "fecha" => "2001" "volumen" => "55" "paginaInicial" => "658" "paginaFinal" => "660" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 65 => array:3 [ "identificador" => "bib0680" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A trial of intrapleural streptokinase" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2005" "volumen" => "352" "paginaInicial" => "2243" "paginaFinal" => "2245" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 66 => array:3 [ "identificador" => "bib0685" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejcts.2005.07.005" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2005" "volumen" => "28" "paginaInicial" => "599" "paginaFinal" => "603" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 67 => array:3 [ "identificador" => "bib0690" "etiqueta" => "68" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Video-assistedthoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas: outcome of 234 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.127.4.1427" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2005" "volumen" => "127" "paginaInicial" => "1427" "paginaFinal" => "1432" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 68 => array:3 [ "identificador" => "bib0695" "etiqueta" => "69" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The diminishing role of surgery in pleural disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCP.0b013e3283474121" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Pulm Med" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "247" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 69 => array:3 [ "identificador" => "bib0700" "etiqueta" => "70" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1510/icvts.2010.240408" "Revista" => array:6 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2010" "volumen" => "11" "paginaInicial" => "171" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000012/v1_201512080104/S1579212915003158/v1_201512080104/en/main.assets" "Apartado" => array:4 [ "identificador" => "46448" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Review Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000012/v1_201512080104/S1579212915003158/v1_201512080104/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003158?idApp=UINPBA00003Z"]

Statistics

Review

Management of parapneumonic pleural effusion in adults

Manejo del derrame pleural paraneumónico en adultos

Lucía Ferreiroa, María Esther San Joséb,c, Luis Valdésa,c,

Corresponding author

luis.valdes.cuadrado@sergas.es

Corresponding author.

a Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, Spain

b Servicio de Análisis Clínicos, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, Spain

c Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, Spain

Read

40169

Times
was read the article

8918

Total PDF

31251

Total HTML

Share statistics

 array:24 [
  "pii" => "S1579212915003158"
  "issn" => "15792129"
  "doi" => "10.1016/j.arbr.2015.10.002"
  "estado" => "S300"
  "fechaPublicacion" => "2015-12-01"
  "aid" => "1133"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2014"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "ssu"
  "cita" => "Arch Bronconeumol. 2015;51:637-46"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 11430
    "formatos" => array:3 [
      "EPUB" => 171
      "HTML" => 8416
      "PDF" => 2843
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0300289615000769"
      "issn" => "03002896"
      "doi" => "10.1016/j.arbres.2015.01.009"
      "estado" => "S300"
      "fechaPublicacion" => "2015-12-01"
      "aid" => "1133"
      "copyright" => "SEPAR"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "ssu"
      "cita" => "Arch Bronconeumol. 2015;51:637-46"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 75218
        "formatos" => array:3 [
          "EPUB" => 190
          "HTML" => 64501
          "PDF" => 10527
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Revisi&#243;n</span>"
        "titulo" => "Manejo del derrame pleural paraneum&#243;nico en adultos"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "637"
            "paginaFinal" => "646"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Management of Parapneumonic Pleural Effusion in Adults"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 1819
                "Ancho" => 2903
                "Tamanyo" => 433718
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#41;<span class="elsevierStyleHsp" style=""></span>Derrame pleural anecoico&#46; B&#41;<span class="elsevierStyleHsp" style=""></span>Derrame pleural con m&#250;ltiples septos y loculaciones&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">L&#58; loculaci&#243;n&#59; LP&#58; l&#237;quido pleural&#59; S&#58; septo&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Luc&#237;a Ferreiro, Mar&#237;a Esther San Jos&#233;, Luis Vald&#233;s"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Luc&#237;a"
                "apellidos" => "Ferreiro"
              ]
              1 => array:2 [
                "nombre" => "Mar&#237;a Esther"
                "apellidos" => "San Jos&#233;"
              ]
              2 => array:2 [
                "nombre" => "Luis"
                "apellidos" => "Vald&#233;s"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1579212915003158"
          "doi" => "10.1016/j.arbr.2015.10.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003158?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615000769?idApp=UINPBA00003Z"
      "url" => "/03002896/0000005100000012/v2_201511280826/S0300289615000769/v2_201511280826/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1579212915003031"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2015.09.012"
    "estado" => "S300"
    "fechaPublicacion" => "2015-12-01"
    "aid" => "1150"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "ssu"
    "cita" => "Arch Bronconeumol. 2015;51:647-53"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 4850
      "formatos" => array:3 [
        "EPUB" => 155
        "HTML" => 3571
        "PDF" => 1124
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Updates on <span class="elsevierStyleItalic">Aspergillus</span>&#44; <span class="elsevierStyleItalic">Pneumocystis</span> and Other Opportunistic Pulmonary Mycoses"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "647"
          "paginaFinal" => "653"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Actualizaci&#243;n sobre <span class="elsevierStyleItalic">Aspergillus</span>&#44; <span class="elsevierStyleItalic">Pneumocystis</span> y otras micosis pulmonares oportunistas"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1074
              "Ancho" => 1614
              "Tamanyo" => 90993
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Association between degree of immunodeficiency and type of pulmonary aspergillosis&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jos&#233; Curbelo, Jos&#233; Mar&#237;a Galv&#225;n, Javier Aspa"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "Curbelo"
            ]
            1 => array:2 [
              "nombre" => "Jos&#233; Mar&#237;a"
              "apellidos" => "Galv&#225;n"
            ]
            2 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Aspa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S030028961500099X"
        "doi" => "10.1016/j.arbres.2015.02.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028961500099X?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003031?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005100000012/v1_201512080104/S1579212915003031/v1_201512080104/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1579212915003122"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2015.09.021"
    "estado" => "S300"
    "fechaPublicacion" => "2015-12-01"
    "aid" => "1065"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Arch Bronconeumol. 2015;51:632-6"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 3184
      "formatos" => array:3 [
        "EPUB" => 153
        "HTML" => 2211
        "PDF" => 820
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Long-term Outcome of Patients with Undiagnosed Pleural Effusion"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "632"
          "paginaFinal" => "636"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Resultados del seguimiento a largo plazo de pacientes con derrame pleural no diagnosticado"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Gulsah Gunluoglu, Aysun Olcmen, Mehmet Zeki Gunluoglu, Ibrahim Dincer, Adnan Sayar, Gungor Camsari, Veysel Yilmaz, Sedat Altin"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "Gulsah"
              "apellidos" => "Gunluoglu"
            ]
            1 => array:2 [
              "nombre" => "Aysun"
              "apellidos" => "Olcmen"
            ]
            2 => array:2 [
              "nombre" => "Mehmet Zeki"
              "apellidos" => "Gunluoglu"
            ]
            3 => array:2 [
              "nombre" => "Ibrahim"
              "apellidos" => "Dincer"
            ]
            4 => array:2 [
              "nombre" => "Adnan"
              "apellidos" => "Sayar"
            ]
            5 => array:2 [
              "nombre" => "Gungor"
              "apellidos" => "Camsari"
            ]
            6 => array:2 [
              "nombre" => "Veysel"
              "apellidos" => "Yilmaz"
            ]
            7 => array:2 [
              "nombre" => "Sedat"
              "apellidos" => "Altin"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289614003901"
        "doi" => "10.1016/j.arbres.2014.09.016"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614003901?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003122?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005100000012/v1_201512080104/S1579212915003122/v1_201512080104/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
    "titulo" => "Management of parapneumonic pleural effusion in adults"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "637"
        "paginaFinal" => "646"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Luc&#237;a Ferreiro, Mar&#237;a Esther San Jos&#233;, Luis Vald&#233;s"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "Luc&#237;a"
            "apellidos" => "Ferreiro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Mar&#237;a Esther"
            "apellidos" => "San Jos&#233;"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          2 => array:4 [
            "nombre" => "Luis"
            "apellidos" => "Vald&#233;s"
            "email" => array:1 [
              0 => "luis&#46;valdes&#46;cuadrado&#64;sergas&#46;es"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Neumolog&#237;a&#44; Complejo Hospitalario Cl&#237;nico-Universitario de Santiago&#44; Santiago de Compostela&#44; La Coru&#241;a&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de An&#225;lisis Cl&#237;nicos&#44; Complejo Hospitalario Cl&#237;nico-Universitario de Santiago&#44; Santiago de Compostela&#44; La Coru&#241;a&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Grupo Interdisciplinar de Investigaci&#243;n en Neumolog&#237;a&#44; Instituto de Investigaciones Sanitarias de Santiago &#40;IDIS&#41;&#44; Santiago de Compostela&#44; La Coru&#241;a&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Manejo del derrame pleural paraneum&#243;nico en adultos"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Adapted from Bhatnagar and Maskell&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">16</span></a>"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2661
            "Ancho" => 4167
            "Tamanyo" => 500173
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Physiopathology&#44; appearance&#44; biochemical parameters and microbiology of parapneumonic pleural effusion&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Parapneumonic pleural effusion &#40;PPE&#41; refers to a pleural effusion &#40;PE&#41; associated with bacterial pneumonia&#44; a pulmonary abscess&#44; or infected bronchiectasis&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">1</span></a> When not accompanied by parenchymal disease&#44; it is known as a pleural infection &#40;PI&#41; or complicated PE &#40;CPE&#41;&#46; Although most PPEs can be resolved with antibiotic treatment alone&#44; a subgroup of patients can present severe complications&#44; such as&#58; PPE refractory to antibiotic treatment and chest drainage &#40;CD&#41;&#44; requiring surgical drainage &#40;33&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">2</span></a>&#59; pleural fibrosis &#40;14&#37;&#41;&#59; prolonged hospital stay &#40;mean 12&#8211;15 days and &#62;1 month in 25&#37; of cases&#41;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a>&#59; and high mortality rates &#40;10&#8211;20&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">2&#44;4&#44;6</span></a> In order to avoid these&#44; a firm diagnosis must be reached as soon as possible&#44; and close clinical monitoring established&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Epidemiology</span><p id="par0010" class="elsevierStylePara elsevierViewall">Of the one million patients hospitalized annually in the United States for pneumonia&#44; around 60&#44;000 will present empyema&#44; and a further 25&#44;000 will develop it for other reasons&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">7</span></a> Despite clinical advances&#44; the incidence of PI&#44; irrespective of its stage of development&#44; is increasing worldwide<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">5&#44;8</span></a> across all age groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">9&#8211;11</span></a> In the United States&#44; the rate of hospitalization for empyema doubled from 1996 to 2008 &#40;from 3&#46;04 to 5&#46;98&#47;100&#44;000 population&#41;&#44; across all age groups&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Physiopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">There are 3 phases in the evolution of PPE&#46; In the first &#40;exudative&#41; phase&#44; pleural fluid &#40;PF&#41; forms as a consequence of localized inflammation and activation of the immune system&#46; The activated neutrophils can cause an endothelial lesion&#44; which will increase capillary permeability and lead to onset of PE&#46;<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">13&#44;14</span></a> The pleural damage can lead to commencement of the second phase &#40;fibrinopurulent&#41;&#44; with the activation of pro-inflammatory and pro-fibrinotic components&#44; and initiation of the coagulation cascade&#46; The local inflammatory response is thus amplified by the presence of various cytokines&#44; which stimulate chemotaxis of neutrophils and fibroblasts&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">14</span></a> Furthermore&#44; membrane permeability can allow bacteria to enter the pleural space&#46; In the latter stages of this phase&#44; PF resembling empyema may be observed due to the presence of cellular degradation products and bacterial remains&#46; During this period&#44; there is also a decrease in fibrinolysis&#44; thereby increasing fibrin formation in the pleural space&#46; This process can progress to the final &#40;organizing&#41; phase&#44; in which a layer of fibrosis is formed on both pleural surfaces due to the increase in fibroblastic infiltration&#46; As a result&#44; these cases can be extremely difficult to manage without resorting to surgery<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">15&#44;16</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The appearance&#44; analysis and culture of PE can vary in each of the evolutionary phases of PPE&#46; The physiopathological changes that take place in the pleural space mean that&#44; from a clinical point of view&#44; PPE can be classified as&#58; uncomplicated PPE &#40;UPPE&#41;&#44; which is resolved with antibiotic treatment&#59; complicated PPE &#40;CPPE&#41;&#44; which will require CD or surgery for resolution&#59; and empyema&#44; i&#46;e&#46; the presence of pus in the pleural space&#44; which must always be drained&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Diagnosis</span><p id="par0020" class="elsevierStylePara elsevierViewall">Diagnosing PPE is not complex in patients presenting with classic symptoms&#44; which are similar to pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">17</span></a> A poor response to pneumonia therapy could suggest the presence of a PPE or empyema as a complication of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">18</span></a> It is sometimes difficult to suspect a PI&#44; as the symptoms are atypical&#44; and there is no evidence of pneumonia on chest radiograph&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a> Blood cultures are only positive in 12&#37; of cases&#44; PF culture is negative in more than 40&#37; of samples<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">2</span></a> and&#44; occasionally&#44; the microorganisms responsible are very rare and can only be identified by molecular microbiology&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a> Although the criteria for defining CPPEs are well established&#44;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">17</span></a> there are no clinical or radiological data to determine which patients will go on to develop CPPE&#47;empyema&#46; As these are easily identifiable by their appearance&#44; the difficulty lies in detecting &#40;as early as possible&#41; which patients with non-purulent PPE might progress to CPPE&#46; Various diagnostic methods have been used for this purpose&#44; but results have so far been disappointing&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pneumonia severity scales and scores</span><p id="par0025" class="elsevierStylePara elsevierViewall">Pneumonia severity scales<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">18&#44;21</span></a> have been used to predict 30-day mortality following admission&#44; but not to assess the likelihood of developing CPPE&#47;empyema&#46; Chalmers et al&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">22</span></a> showed that these scales and generic sepsis scoring systems &#40;APACHE II&#44; SEWS and SIRS&#41; cannot predict the development of CPPE&#47;empyema&#46; However&#44; multivariate logistic regression has identified that&#58; albumin<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>g&#47;l&#44; Na<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>130<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#44; platelet count<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>400&#44;000&#44; C-reactive protein &#40;CRP&#41;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;l and a history of alcohol abuse and intravenous drug use are independent risk factors for CPPE&#47;empyema&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">22</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Rahman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">23</span></a> developed a validated clinical risk score &#40;RAPID&#41; to identify patients with PI and high risk of dying&#44; to enable clinicians to implement the best management strategy&#46; The score includes urea levels&#44; age&#44; presence of purulent PF&#44; source of infection &#40;community or hospital&#41;&#44; and dietary factors &#40;albumin&#41;&#46; Patients can then be divided into low&#44; medium and high-risk groups according to the score&#46; The odds ratio for mortality at 3 months for the medium- and high-risk groups&#44; using the low-risk group as a reference&#44; is 24&#46;4 and 192&#46;4&#44; respectively&#46; Using this system&#44; patients with PI at presentation can be stratified according to risk&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Imaging tests</span><p id="par0035" class="elsevierStylePara elsevierViewall">Radiographs&#44; chest ultrasound &#40;CU&#41; and chest computed tomography &#40;CT&#41; can provide information on the size&#44; extent and nature of the PE&#46; PF volumes of &#62;200&#8211;250<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> are usually seen on the chest radiograph&#44; and CPPE may be suspected if opacification of the pleural space does not change with the gravitational effects of the PF&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">CU is a key technique in the management of PE&#44; particularly PPE&#44; and pulmonologists must be competent in its use&#46; It is more sensitive than radiography for detecting minor PE&#44; establishes the echogenicity of the PF&#44; precisely locates the loculated fluid&#44; estimates the volume and depth of the PE&#44; differentiates between PF and underlying consolidation or atelectasia&#44; improves the yield of thoracocentesis&#44; and reduces the risk of complications compared to physical examination plus radiography&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">24</span></a> An ultrasound finding of septa suggests CPPE &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; and hyperechogenicity is associated with pus in the pleural cavity&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">CT provides the clearest image of the pleura&#44; and can be used to reconstruct images&#44; determine loculations&#44; and reveal lesions in the underlying lung&#46; It also differentiates between a peripheral pulmonary abscess and a loculated PI&#44; though the split pleura sign&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">25</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">CU&#44; being radiation-free and easily performed at the bedside in critically ill patients&#44; should be the technique of choice&#46; Factors that may affect image quality&#44; such as obesity or subcutaneous emphysema&#44; and suspicion of malignant PE or pleural infection with comorbidity &#40;esophageal rupture&#44; bronchopleural fistula&#44; etc&#46;&#41;&#44; in which other anatomical abnormalities must be identified&#44; may make it necessary to perform a CT scan&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Microbiology</span><p id="par0055" class="elsevierStylePara elsevierViewall">A positive PF culture is diagnostic of PI&#44; but this only occurs in 58&#37; of cases&#46; This proportion increases to 74&#37; if molecular microbiology is used&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a> PI is thought to occur as a result of migration of the bacteria present in the lung parenchyma&#44; so such infections are usually called CPPEs&#44; on the assumption that the bacterial etiology of all PIs is the same as that of pneumonia&#46; However&#44; in a review of 14 studies with a total of 1383 patients with empyema&#44; only 70&#37; were due to pneumonia and the rest were due to other causes&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">26</span></a> Therefore&#44; basing the choice of antibiotic for treating PI on this assumption is not the best strategy&#44; as there are major bacteriological differences between PI and pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a> These differences are probably due to significant differences in acidity and oxygenation between the infected pleural space and the ventilated lung&#44; thus predisposing it to invasion by certain organisms over others&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">27</span></a> There are also differences &#40;as regards the types of microorganisms&#41; between community- and hospital-acquired PIs<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The heptavalent pneumococcal vaccine could play a major role in the evolution of the microbiology of PI&#44; since it has been observed that the predominant serotypes that cause PI are those not covered by the vaccine&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">28</span></a> This seems to correlate with a significant increase in the incidence of empyema&#44;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">29</span></a> which suggests an increase in the virulence of the new microorganisms&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Pleural fluid analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">The combination of clinical symptoms&#44; physical examination&#44; blood tests and chest radiography usually confirms the presence of pneumonia with PPE&#46; PF analysis is the most reliable method for diagnosing the condition&#44; and for trying to prevent progression to CPPE&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">30</span></a> Thoracocentesis is therefore recommended in all patients with suspected infectious PE if the pleural fluid thickness in the chest radiograph obtained in lateral decubitus is &#62;10<span class="elsevierStyleHsp" style=""></span>mm&#44;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a> although the likelihood of a PPE<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm in depth on the CT scan progressing to CPPE is small&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">31</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">PF analysis can vary in each of the evolutionary phases of PPE&#46; The tests to be performed when PPE is suspected are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; A UPPE is a polymorphonuclear &#40;PMN&#41; predominant exudate with a serous appearance&#44; normal biochemical findings&#44; and negative culture&#46; If the patient has previously received antibiotics&#44; the nucleated cells will be predominantly lymphocytic&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">32</span></a> Biochemistry tests in PF&#44; however&#44; are most useful as a tool for early detection CPPEs&#47;empyema&#46; While empyema always requires drainage&#44; the decision to drain a non-purulent PPE is based on the morphological &#40;&#62;1&#47;2 hemithorax&#44; loculations and thickening of the parietal pleura&#41;&#44; bacteriological &#40;culture&#41; and biochemical characteristics &#40;pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#46;20&#41; of the PE&#46;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">19&#44;33</span></a> Lactate dehydrogenase &#40;LDH&#41;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1000<span class="elsevierStyleHsp" style=""></span>IU&#47;l and glucose<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl do not improve the diagnostic yield&#44; and will only be used if the pH cannot be determined&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a> Factors such as air or traces of heparin or local anesthetic in the sample syringe can alter the pH results&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">34</span></a> Furthermore&#44; PIs caused by <span class="elsevierStyleItalic">Proteus</span> spp&#46; can secrete enzymes that alkalize the PF&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">35</span></a> Some patients with an initial pleural pH<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>7&#46;20 may also require CD and even surgery&#46; This is due to the heterogeneity of the biochemical characteristics in the loculated PE&#44; since the degree of involvement of the aspirated chamber can significantly affect disease severity indices&#44; as determined by pH&#46; Therefore&#44; although pleural pH is highly specific &#40;91&#46;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">36</span></a> in predicting the need for CD&#44; it is less sensitive in determining mortality or the eventual need for surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">4&#44;19</span></a> While leading scientific societies accept this parameter for draining a PE&#44;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">19&#44;33</span></a> a retrospective analysis has shown that this test is not highly specific in establishing the need for CD in non-purulent PE&#44; i&#46;e&#46; a group of patients with UPPE are considered as CPPE&#44; which results in the needless placement of chest drains&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">37</span></a> The total nucleated cell count and percentage of PMN leucocytes are usually higher in CPPE&#47;empyemas&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">38</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Alternative biomarkers in pleural fluid</span><p id="par0075" class="elsevierStylePara elsevierViewall">CRP has been used to differentiate both PPE from non-parapneumonic exudates&#44;<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">38&#8211;41</span></a> and UPPE from CPPE<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">38&#44;39</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; It should be noted that the specificity of this test increases &#40;96&#37;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">38</span></a> and 92&#37;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">40</span></a>&#41; if high CRP values are combined with a predominance of PMNs in the PF&#46; Moreover&#44; if a CRP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;l is accompanied by a pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#46;20 or glucose<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; the specificity for the diagnosis of CPPE is 97&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">38</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Although procalcitonin &#40;PCT&#41; values are high in bacterial infections&#44; the advantage of determining this peptide in PF and its capacity to differentiate CPPEs from UPPEs remains unclear&#46;<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">39&#8211;42</span></a> Nevertheless&#44; a recent study confirmed that PCT is a specific biomarker for infection&#44; and that PCT levels are not affected by non-infectious inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">43</span></a> Furthermore&#44; PCT differentiates PPE from non-infectious PPE better than CRP&#44; although it does not predict the need for surgery or risk of death&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">43</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The diagnostic yield of other parameters such as tumor necrosis factor-alpha &#40;TNF-&#945;&#41;&#44; interleukin &#40;IL&#41;-6&#44; IL-1&#946;&#44; IL-8&#44; complement products &#40;soluble form of C5b-9&#41;&#44; neutrophil-derived enzymes &#40;polymorphonuclear elastase and myeloperoxidase&#41;&#44; lipopolysaccharide binding protein &#40;LBP&#41;&#44; and soluble receptor activator expressed in myeloid cells &#40;sTREM-1&#41;&#44; are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">39&#44;44&#8211;53</span></a> There is skepticism among investigators about the likelihood of a single parameter &#40;especially without taking into account clinical&#44; radiological or microbiological data&#41; being capable of diagnosing PI with sufficient certainty to change current clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">54</span></a></p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Treatment</span><p id="par0090" class="elsevierStylePara elsevierViewall">Treatment is based on controlling infection with appropriate antibiotics&#44; draining the CPPE&#47;empyema&#44; assessing the use of fibrinolytics and existing surgical options&#44; ensuring good nutrition&#44; and administering anti-thrombotic prophylaxis&#46;<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">55</span></a></p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Antibiotics</span><p id="par0095" class="elsevierStylePara elsevierViewall">The use of antibiotics should be based on local microbiological recommendations and on the specific risks of each patient&#46; Treatment should be initiated empirically and promptly&#44; and adjusted to the community or nosocomial origin of the infection&#44; culture results&#44; and activity of the antibiotic in the PF&#46;<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">56</span></a> In community-acquired PIs&#44; the recommended combination is amoxicillin-clavulanic acid as monotherapy&#44; or a third-generation cephalosporin and clindamycin&#47;metronidazole&#46; If the patient is allergic to penicillin&#44; a quinolone can be combined with clindamycin&#47;metronidazole&#46; In nosocomial PIs&#44; in which methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> is very common&#44;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a> the empirical regimen should cover this and anaerobic microorganisms &#40;e&#46;g&#46; vancomycin&#47;linezolid&#44; anti-<span class="elsevierStyleItalic">Pseudomonas</span> penicillins&#44; carbapenem or third-generation cephalosporins combined with metronidazole&#41;&#46; Macrolides are not generally used&#44; since although pneumonia caused by <span class="elsevierStyleItalic">Legionella</span> or <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> can present with PE&#44; it is usually self-limiting and rarely causes empyema&#46;<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">57</span></a> The use of aminoglycosides is not recommended&#44; due to their poor penetration in the pleural space&#44; nor is there evidence to recommend the intra-pleural use of antibiotics&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Chest drainage</span><p id="par0100" class="elsevierStylePara elsevierViewall">Although there is no consensus on the caliber of the drainage tube&#44; <span class="elsevierStyleItalic">British Thoracic Society</span><a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a> guidelines and other studies<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">58</span></a> suggest that small bore tubes &#40;10&#8211;14<span class="elsevierStyleHsp" style=""></span>F&#41; are suitable for most CPPEs&#44; as they are easier to place&#44; are less traumatic and painful for the patient&#44; and are as effective as larger bore tubes &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Insertion of a chest catheter should always be image-guided&#44; generally using CU&#46; It is indicated in patients with cloudy or purulent PF&#44; positive PF staining or culture&#44; loculation or PE greater than half the hemithorax&#44; pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#46;20&#44; or thickening of the parietal pleura&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Fibrinolytics</span><p id="par0105" class="elsevierStylePara elsevierViewall">There are no indications in current guidelines for the routine use of intrapleural fibrinolytics in patients with PI&#44;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a> and their systematic use in the management of CPPE is controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">59</span></a> A Cochrane review confirmed that intrapleural fibrinolytics are beneficial in both reducing treatment failure and the need for surgery in loculated PEs or empyema&#44; although they do not affect mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">60</span></a> In patients who received alteplase &#40;a tissue plasminogen activator&#41; and deoxyribonuclease &#40;DNase&#41;&#44; pleural opacity on radiography&#44; need for surgery at 3 months&#44; and mean hospital stay were significantly improved compared to placebo&#46;<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">61</span></a> A meta-analysis that included this study &#40;and others using streptokinase and urokinase&#41; showed heterogeneous results&#44; but suggested that treatment with fibrinolytics reduces the need for surgery&#44; but not the risk of mortality &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">3&#44;61&#8211;67</span></a> Current guidelines recommend the prompt use of fibrinolytics when there are loculations in the pleural cavity &#40;resistant to CD&#41; and in empyema&#46; There is insufficient evidence to recommend one drug over another&#44; and no consensus on the recommended dose&#46;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">19&#44;55</span></a> Guidelines also recommend closing the CD tube for a few hours after fibrinolytic administration&#46;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">19&#44;61</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Surgery</span><p id="par0110" class="elsevierStylePara elsevierViewall">Surgery &#40;video-assisted thoracoscopic surgery &#91;VATS&#93; drainage&#59; thoracotomy with pleural decortication&#44; or other type of open surgical drainage&#41; must be considered when medical treatment &#40;antibiotics&#44; CD and fibrinolytics&#41; fails after 5&#8211;7 days&#44;<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">16&#44;19&#44;55</span></a> or when organized empyema is established and there is evidence of significant pleural fibrosis&#46; The early finding of purulent PF or loculations is not predictive of surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">2</span></a> In addition to pleural debridement&#44; VATS facilitates decortication in advanced or chronic empyema&#46; In the latter&#44; the outcomes are poorer&#44; as the highest success rates are obtained when the procedure is performed at an early stage&#46; Nevertheless&#44; the overall success rate of this technique exceeds 85&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">68</span></a> Several studies have compared conservative treatment &#40;antibiotics and CD with&#47;without fibrinolytics&#41; with VATS as first line treatment in both children and adults&#46; Early surgery has not shown any advantages in mortality or severe morbidity in any trials&#46;<a class="elsevierStyleCrossRef" href="#bib0695"><span class="elsevierStyleSup">69</span></a> Moreover&#44; surgery is not free from complications&#44; particularly post-surgical pleural intercostal neuralgia&#46; Decortication by thoracotomy in empyema is being increasingly replaced by VATS&#44; in light of evidence that the latter is at least comparable&#44; or even better&#44;<a class="elsevierStyleCrossRef" href="#bib0700"><span class="elsevierStyleSup">70</span></a> and is usually reserved for cases in which less invasive procedures have failed&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Nutrition</span><p id="par0115" class="elsevierStylePara elsevierViewall">Poor nutrition is an adverse determinant in pleural empyema outcome&#44; although this factor is not generally taken into account&#46; PIs associated with hypoalbuminemia have a worse outcome&#44;<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">16&#44;19&#44;55</span></a> and patients should be given adequate nutritional support&#44; including complementary enteral feeding&#44; as soon as diagnosis is confirmed&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Anti-thrombotic prophylaxis</span><p id="par0120" class="elsevierStylePara elsevierViewall">All patients hospitalized for pneumonia and&#47;or PI should receive prophylaxis with low molecular weight heparins&#44; if these are not contraindicated&#46;<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">16&#44;19&#44;55</span></a></p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">The incidence of PPE is increasing worldwide&#44; across all age groups&#46; Although related with pneumonia&#44; there is little correlation between organisms found in the pleural space and those observed in lung parenchyma infections&#44; suggesting that primary PI is more common than previously thought&#46; Current diagnostic methods focus on being able to predict whether a PPE will progress to a CPPE&#47;empyema&#46; Diagnosis and early strategies such as antibiotic regimens and CT continue to form the basis of treatment&#46; In a sub-group of patients&#44; fibrinolytics help to improve recovery&#44; and have been associated with better outcome when combined with DNase&#46; If surgery is necessary&#44; there is increasing evidence that VATS is comparable to&#44; if not better than&#44; decortication by thoracotomy&#44; and so should be reserved for cases in which less invasive procedures have failed &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Further clinical trials are needed to define evidence-based diagnostic and therapeutic strategies that provide more effective&#44; standardized management of this disease&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Authors&#8217; contributions</span><p id="par0130" class="elsevierStylePara elsevierViewall">Ferreiro L&#46; and Vald&#233;s L&#46; are the authors and editors and also contributed in conception&#44; design and final approval of the manuscript&#46; San Jos&#233; ME is the co-author and editor&#46; He helped in final approval of the manuscript&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:14 [
        0 => array:3 [
          "identificador" => "xres587071"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec602847"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xpalclavsec602849"
          "titulo" => "Abreviaturas"
        ]
        3 => array:3 [
          "identificador" => "xres587072"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        4 => array:2 [
          "identificador" => "xpalclavsec602848"
          "titulo" => "Palabras clave"
        ]
        5 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        6 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Epidemiology"
        ]
        7 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Physiopathology"
        ]
        8 => array:3 [
          "identificador" => "sec0020"
          "titulo" => "Diagnosis"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Pneumonia severity scales and scores"
            ]
            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Imaging tests"
            ]
            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Microbiology"
            ]
            3 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Pleural fluid analysis"
            ]
            4 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Alternative biomarkers in pleural fluid"
            ]
          ]
        ]
        9 => array:3 [
          "identificador" => "sec0050"
          "titulo" => "Treatment"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Antibiotics"
            ]
            1 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Chest drainage"
            ]
            2 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Fibrinolytics"
            ]
            3 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Surgery"
            ]
            4 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Nutrition"
            ]
            5 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Anti-thrombotic prophylaxis"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conclusions"
        ]
        11 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Authors&#8217; contributions"
        ]
        12 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Conflict of interest"
        ]
        13 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-11-24"
    "fechaAceptado" => "2015-01-16"
    "PalabrasClave" => array:2 [
      "en" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec602847"
          "palabras" => array:8 [
            0 => "Parapneumonic pleural effusion"
            1 => "Complicated parapneumonic pleural effusion"
            2 => "Empyema"
            3 => "Chest drainage"
            4 => "Pleural fluid analysis"
            5 => "Culture of pleural fluid"
            6 => "Intrapleural fibrinolytics"
            7 => "Thoracoscopy"
          ]
        ]
        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abreviaturas"
          "identificador" => "xpalclavsec602849"
          "palabras" => array:2 [
            0 => "AUC"
            1 => "IL"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec602848"
          "palabras" => array:8 [
            0 => "Derrame pleural paraneum&#243;nico"
            1 => "Derrame pleural paraneum&#243;nico complicado"
            2 => "Empiema"
            3 => "Drenaje tor&#225;cico"
            4 => "An&#225;lisis del l&#237;quido pleural"
            5 => "Cultivo del l&#237;quido pleural"
            6 => "Fibrinol&#237;ticos intrapleurales"
            7 => "Toracoscopia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pleural infections have high morbidity and mortality&#44; and their incidence in all age groups is growing worldwide&#46; Not all infectious effusions are parapneumonic and&#44; in such cases&#44; the organisms found in the pleural space are not the same as those observed in lung parenchyma infections&#46; The diagnostic difficulty lies in knowing whether an infectious effusion will evolve into a complicated effusion&#47;empyema&#44; as the diagnostic methods used for this purpose provide poor results&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The mainstays of treatment are to establish an early diagnosis and to commence an antibiotic regimen and chest drain as soon as possible&#46; This should preferably be carried out with fine tubes&#44; due to certain morphological&#44; bacteriological and biochemical characteristics of the pleural fluid&#46; Fluid analysis&#44; particularly pH&#44; is the most reliable method for assessing evolution&#46; In a subgroup of patients&#44; fibrinolytics may help to improve recovery&#44; and their combination with DNase has been found to obtain better results&#46; If medical treatment fails and surgery is required&#44; video-assisted thoracoscopic surgery &#40;VATS&#41; is&#44; at least&#44; comparable to decortication by thoracotomy&#44; so should only undertaken if previous techniques have failed&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Further clinical trials are needed to analyze factors that could affect the results obtained&#44; in order to define new evidence-based diagnostic and therapeutic strategies that provide more effective&#44; standardized management of this disease&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las infecciones pleurales presentan una elevada morbimortalidad&#44; y su incidencia est&#225; aumentando en todos los pa&#237;ses del mundo y en todos los grupos de edad&#46; No todos los derrames infecciosos son paraneum&#243;nicos&#44; y en esos casos&#44; los organismos que se encuentran en el espacio pleural no son los mismos que se observan en las infecciones del par&#233;nquima pulmonar&#46; La dificultad diagn&#243;stica radica en saber si un derrame infeccioso evolucionar&#225; hacia un derrame complicado&#47;empiema&#44; ya que los m&#233;todos diagn&#243;sticos utilizados con este fin ofrecen pobres resultados&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los pilares del tratamiento son establecer un diagn&#243;stico precoz e instaurar&#44; lo antes posible&#44; una pauta antibi&#243;tica y un drenaje tor&#225;cico&#46; Este se llevar&#225; a cabo&#44; preferiblemente con tubos de peque&#241;o calibre&#44; ante la presencia de determinadas caracter&#237;sticas morfol&#243;gicas&#44; bacteriol&#243;gicas y bioqu&#237;micas del l&#237;quido pleural&#46; El an&#225;lisis del l&#237;quido es el m&#233;todo m&#225;s fiable para valorar su evoluci&#243;n&#44; sobre todo la determinaci&#243;n del pH&#46; En un subgrupo de pacientes los fibrinol&#237;ticos pueden contribuir a mejorar la recuperaci&#243;n&#44; y su combinaci&#243;n con deoxirribonucleasa se relaciona con la obtenci&#243;n de mejores resultados&#46; Si fracasa el tratamiento m&#233;dico y es necesaria la cirug&#237;a&#44; la rentabilidad de la cirug&#237;a toracosc&#243;pica videoasistida es&#44; al menos&#44; comparable a la decorticaci&#243;n por toracotom&#237;a&#44; por lo que esta solamente se realizar&#225; si han fallado las t&#233;cnicas anteriores&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Son necesarios m&#225;s ensayos cl&#237;nicos que analicen factores que puedan influir sobre los resultados obtenidos para conformar nuevas estrategias diagn&#243;sticas y terap&#233;uticas basadas en la evidencia&#44; que proporcionen un manejo m&#225;s efectivo y estandarizado de esta enfermedad&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Ferreiro L&#44; San Jos&#233; ME&#44; Vald&#233;s L&#46; Manejo del derrame pleural paraneum&#243;nico en adultos&#46; Arch Bronconeumol&#46; 2015&#59;51&#58;637&#8211;646&#46;</p>"
      ]
    ]
    "multimedia" => array:8 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Adapted from Bhatnagar and Maskell&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">16</span></a>"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2661
            "Ancho" => 4167
            "Tamanyo" => 500173
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Physiopathology&#44; appearance&#44; biochemical parameters and microbiology of parapneumonic pleural effusion&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1819
            "Ancho" => 2903
            "Tamanyo" => 428709
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Anechoic pleural effusion&#46; &#40;B&#41; Pleural effusion with multiple septa and loculations&#46; L&#44; loculation&#59; PF&#44; pleural fluid&#59; S&#44; septum&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1683
            "Ancho" => 3170
            "Tamanyo" => 219604
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Microbiology of community- and hospital-acquired pleural infection&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a> MRSA&#44; Methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Fig&#46; 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 2125
            "Ancho" => 3210
            "Tamanyo" => 339062
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Treatment algorithm for parapneumonic pleural effusion&#46; CD&#44; chest drainage&#59; CT&#44; computed tomography&#59; CU&#44; chest ultrasound&#59; G&#44; generation&#59; MR&#44; medical record&#59; PE&#44; pleural effusion&#59; PEx physical examination&#59; PF&#44; pleural fluid&#59; PPE&#44; parapneumonic pleural effusion&#46; <span class="elsevierStyleSup">1</span> If allergic to penicillin&#58; quinolone<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>metronidazole&#46; <span class="elsevierStyleSup">2</span> If the pH cannot be determined&#44; use LDH<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1000<span class="elsevierStyleHsp" style=""></span>IU&#47;l or glucose<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ADA&#44; adenosine deaminase&#59; CPPE&#44; complicated parapneumonic pleural effusion&#59; CRP&#44; C-reactive protein&#59; LDH&#44; lactate dehydrogenase&#59; PF&#44; pleural fluid&#59; PPE&#44; parapneumonic pleural effusion&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics of CPPE&#47;empyema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Likely if &#60; 7&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Should be measured on a blood gas analyzerLow values if acidosis in the pleural space&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Likely if &#60; 60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Due to the increase in cell metabolism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LDH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Likely if &#62; 1000<span class="elsevierStyleHsp" style=""></span>IU&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Measure in PF and bloodDue to cell destruction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Total protein&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;3<span class="elsevierStyleHsp" style=""></span>g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Measure in PF and blood&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Total and percentage nucleated cell count&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">High total count with predominance of polymorphonuclear cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Highly scattered values&#44; as it depends on involvement of the aspirated pleural chamber&#46;If previously treated with antibiotics&#44; the predominant cell type could be lymphocytic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CRP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Likely if &#62;100<span class="elsevierStyleHsp" style=""></span>mg&#47;l and accompanied by a pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#46;20 or glucose<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">High specificity for diagnosis of PPE if associated with predominantly polymorphonuclear cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PF culture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">May be positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Higher diagnostic yield if collected in blood culture bottles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PF cytology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Changes similar to those in PPE occasionally observed in the fluid of malignant effusions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ADA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">May be elevatedPredominance of polymorphonuclear cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To be determined if tuberculosis is suspected&#59; in this case&#44; predominantly lymphocytic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab958621.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Pleural fluid testing when an infectious pleural effusion is suspected&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">AUC&#44; area under the curve&#59; CPPE&#44; complicated parapneumonic pleural effusion&#59; CRP&#44; C-reactive protein&#59; IL&#44; interleukin&#59; LBP&#44; lipopolysaccharide-binding proteins&#59; PPE&#44; parapneumonic pleural effusion&#59; Ref&#44; reference&#59; SC5b-9&#44; soluble form of C5b-9&#59; Se&#44; sensitivity&#59; Sp&#44; specificity&#59; sTREM-1&#44; soluble triggering receptor expressed on myeloid cells-1&#59; TNF-&#945;&#44; tumor necrosis factor alpha&#59; UPPE&#44; uncomplicated parapneumonic pleural effusion&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Parameter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PPE versus other effusions</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">UPPE versus CPPE&#47;empyema</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cut-off point&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AUC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Se &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cut-off point&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AUC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Se &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CRP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;45<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#62;80<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#62;3&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;820&#46;830&#46;750&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75497354&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75937377&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;100<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#62;80<span class="elsevierStyleHsp" style=""></span>mg&#47;&#62;80<span class="elsevierStyleHsp" style=""></span>mg&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;810&#46;810&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">586872&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">887571&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">38</span></a><a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">39</span></a><a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">40</span></a><a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">42</span></a><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">49</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Procalcitonin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;0&#46;25<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#62;0&#46;14<span class="elsevierStyleHsp" style=""></span>ng&#47;ml0&#46;18<span class="elsevierStyleHsp" style=""></span>ng&#47;ml0&#46;19<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;570&#46;590&#46;750&#46;830&#46;710&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">455267766765&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">726777817068&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;0&#46;5<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">39</span></a><a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">40</span></a><a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">41</span></a><a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">41</span></a><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">42</span></a><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">42</span></a><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">TNF-&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;80<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">44</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">IL-6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;77&#46;3<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;704&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">46</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">IL-1&#946;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;16&#46;7<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">50</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">IL-8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;1000<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#62;2130<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;870&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8473&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8290&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">49</span></a><a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">50</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">SC5b-9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;2000<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">51</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Polymorphonuclear elastase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;3500<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">52</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Myeloperoxidase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;3000<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">53</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LLP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;17<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;17<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">39</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">sTREM-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;80<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;180<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">39</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab958619.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">In blood&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Meta-analysis&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Diagnostic yield of alternative biomarkers in pleural fluid for the diagnosis of parapneumonic pleural effusions&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Adapted from Rahman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">58</span></a>"
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">F&#44; French&#59; IQR&#44; interquartile range&#59; PE&#44; pleural effusion&#59; PF&#44; pleural fluid&#59; SD&#44; standard deviation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Caliber of tube&#44; F</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">10&#8211;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">15&#8211;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#62;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Patients &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">208&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Sex&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">144 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 &#40;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Opacification chest X-ray due to PE &#40;&#37; of hemithorax&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Characteristics PF</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Purulence&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164 &#40;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65 &#40;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gram positive for bacteria&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Culture positive for bacteria&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>pH&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;89 &#40;0&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;87 &#40;0&#46;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;82 &#40;0&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;64 &#40;0&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Glucose &#40;mmol&#47;l&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;1 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;3 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;2 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;3 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LDH &#40;IU&#47;l&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;580 &#40;34&#46;700&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;820 &#40;22&#46;280&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46;400 &#40;28&#46;300&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;580 &#40;37&#46;550&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Source of infection&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Community&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">163 &#40;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 &#40;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 &#40;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Combination of surgery and death&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#47;58 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#47;208 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#47;70 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#47;69 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Death at 1 year&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#47;58 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#47;208 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#47;70 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#47;69 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Surgery at 1 year&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;58 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#47;208 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#47;70 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#47;69 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hospital stay&#44; days &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">FEV</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">1</span></span><span class="elsevierStyleItalic">at 3 months&#44; L &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;46 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;16 &#40;0&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;30 &#40;0&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;15 &#40;0&#46;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">FVC at 3 months&#44; l &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;30 &#40;1&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;98 &#40;0&#46;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;18 &#40;1&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;84 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Reduction in chest X-ray abnormality with respect to baseline at 3 months&#44; median &#37; hemithorax &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90 &#40;77&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90 &#40;77&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90 &#40;52&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90 &#40;77&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab958620.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Patient characteristics according to the size of the chest-tube caliber and the effect of the caliber on primary and secondary clinical outcomes&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Adapted from Janda and Swiston&#46;<a class="elsevierStyleCrossRef" href="#bib0660"><span class="elsevierStyleSup">62</span></a>"
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">CPPE&#44; complicated parapneumonic pleural effusion&#59; CT&#44; computed tomography&#59; CU&#44; chest ultrasound&#59; E&#44; empyema&#59; F&#44; French&#59; N&#46;S&#46;&#44; not significant&#59; Pbo&#44; placebo group&#59; PPE&#44; parapneumonic pleural effusion&#59; Tx&#44; treatment group&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Patients included&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Types of PPE included&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Image<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Size drainage tube&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mortality &#40;&#37;&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery rate &#40;&#37;&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pbo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pbo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Maskell et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">United Kingdom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">454&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CPPE &#38; E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X-ray&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#8211;20<span class="elsevierStyleHsp" style=""></span>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Streptokinase&#58; 250&#44;000<span class="elsevierStyleHsp" style=""></span>IU&#59; 1 dose&#47;12<span class="elsevierStyleHsp" style=""></span>h&#47;3 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Rahman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">61</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">United Kingdom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CPPE &#38; E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X-ray&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;15<span class="elsevierStyleHsp" style=""></span>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">t-PA &#38; DNase&#58; 10<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mg&#59; 1 dose&#47;12<span class="elsevierStyleHsp" style=""></span>h&#47;3 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Davies et al&#46;<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">63</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">United Kingdom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CPPE &#38; E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X-ray&#44; CU&#44; CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14<span class="elsevierStyleHsp" style=""></span>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Streptokinase&#58; 250&#44;000<span class="elsevierStyleHsp" style=""></span>IU&#59; 1 dose&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;3 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not given&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Bouros et al&#46;<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">64</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Greece&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CPPE &#38; E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CU&#44; CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#8211;32<span class="elsevierStyleHsp" style=""></span>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Urokinase&#58; 100&#44;000<span class="elsevierStyleHsp" style=""></span>IU&#59; 1 dose&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;3 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Tuncozgur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">65</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Turkey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">E stage II<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X-ray&#44; CU&#44; CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#8211;36<span class="elsevierStyleHsp" style=""></span>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Urokinase&#58; 100&#44;000<span class="elsevierStyleHsp" style=""></span>IU&#59; 1 dose&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;3 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diacon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0680"><span class="elsevierStyleSup">66</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">South Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CPPE &#38; E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X-ray&#44; CU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#8211;28<span class="elsevierStyleHsp" style=""></span>F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Streptokinase&#58; 250&#44;000<span class="elsevierStyleHsp" style=""></span>IU&#59; 1 dose&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;7 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Misthos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">67</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Greece&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X-ray&#44; CU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#8211;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Streptokinase&#58; 250&#44;000<span class="elsevierStyleHsp" style=""></span>IU&#59; 1 dose&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;3 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab958622.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Imaging modality used to evaluate the effusions&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Defined by the <span class="elsevierStyleItalic">American Thoracic Society</span>&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Intrapleural fibrinolytic treatment&#46; Characteristics of the placebo-controlled trials&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:70 [
            0 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Parapneumonic effusions and empyema"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;W&#46; Light"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Pleural diseases"
                        "paginaInicial" => "179"
                        "paginaFinal" => "210"
                        "serieFecha" => "2007"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "U&#46;K&#46; controlled trial of intrapleural streptokinase for pleural infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;A&#46; Maskell"
                            1 => "C&#46;W&#46;H&#46; Davies"
                            2 => "A&#46;J&#46; Nunn"
                            3 => "E&#46;L&#46; Hedley"
                            4 => "F&#46;V&#46; Gleeson"
                            5 => "R&#46; Miller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa042473"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2005"
                        "volumen" => "352"
                        "paginaInicial" => "865"
                        "paginaFinal" => "874"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15745977"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic features of residual pleural thickening in parapneumonic pleural effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Jim&#233;nez-Castro"
                            1 => "G&#46; D&#237;az"
                            2 => "E&#46; P&#233;rez-Rodriguez"
                            3 => "R&#46;W&#46; Light"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2003"
                        "volumen" => "21"
                        "paginaInicial" => "952"
                        "paginaFinal" => "955"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12797487"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of outcome and long-term survival in patients with pleural infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;W&#46; Davies"
                            1 => "S&#46;E&#46; Kearney"
                            2 => "F&#46;V&#46; Gleeson"
                            3 => "R&#46;J&#46; Davies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.160.5.9903002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1999"
                        "volumen" => "160"
                        "paginaInicial" => "1682"
                        "paginaFinal" => "1687"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10556140"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Empyema&#58; an increasing concern in Canada"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Finley"
                            1 => "J&#46; Clifton"
                            2 => "J&#46;M&#46; Fitzgerald"
                            3 => "J&#46; Yee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Can Respir J"
                        "fecha" => "2008"
                        "volumen" => "15"
                        "paginaInicial" => "85"
                        "paginaFinal" => "89"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18354748"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The clinical course and management of thoracic empyema"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;D&#46; Ferguson"
                            1 => "R&#46;J&#46; Prescott"
                            2 => "J&#46;B&#46; Selkon"
                            3 => "D&#46; Watson"
                            4 => "C&#46;R&#46; Swinburn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "QJM"
                        "fecha" => "1996"
                        "volumen" => "89"
                        "paginaInicial" => "285"
                        "paginaFinal" => "289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8733515"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and management of parapneumonic effusions and empyema"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;A&#46; Sahn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/522996"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2007"
                        "volumen" => "45"
                        "paginaInicial" => "1480"
                        "paginaFinal" => "1486"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17990232"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of pleural space infections&#58; a population-based analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; Farjah"
                            1 => "R&#46; Symons"
                            2 => "B&#46; Krishnadasan"
                            3 => "D&#46;E&#46; Wood"
                            4 => "D&#46;R&#46; Flum"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2006.09.038"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2007"
                        "volumen" => "133"
                        "paginaInicial" => "346"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17258562"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Li"
                            1 => "D&#46; Tancredi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2009-0184"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2010"
                        "volumen" => "125"
                        "paginaInicial" => "26"
                        "paginaFinal" => "33"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19948570"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complicated community acquired pneumonia in children prior to the introduction of the pneumococcal conjugate vaccine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Goldbart"
                            1 => "E&#46; Leibovitz"
                            2 => "N&#46; Porat"
                            3 => "N&#46; Givon-Lavi"
                            4 => "I&#46; Drukmann"
                            5 => "A&#46; Tal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/00365540802688378"
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Infect Dis"
                        "fecha" => "2009"
                        "volumen" => "41"
                        "paginaInicial" => "182"
                        "paginaFinal" => "187"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19117244"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The epidemiology of hospitalized children with pneumococcal&#47;lobar pneumonia and empyema from 1997 to 2004 in Taiwan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;S&#46; Wu"
                            1 => "L&#46;M&#46; Huang"
                            2 => "I&#46;S&#46; Chang"
                            3 => "C&#46;Y&#46; Lu"
                            4 => "P&#46;L&#46; Shao"
                            5 => "F&#46;Y&#46; Tsai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Paediatr"
                        "fecha" => "2010"
                        "volumen" => "169"
                        "paginaInicial" => "861"
                        "paginaFinal" => "866"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Emergence of parapneumonic empyema in the USA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;G&#46; Grijalva"
                            1 => "Y&#46; Zhu"
                            2 => "J&#46;P&#46; Nuorti"
                            3 => "M&#46;R&#46; Griffin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2010.156406"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2011"
                        "volumen" => "66"
                        "paginaInicial" => "663"
                        "paginaFinal" => "668"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21617169"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pleural fluid tests to identify complicated parapneumonic effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;M&#46; Porcel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCP.0b013e328338a108"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Pulm Med"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "357"
                        "paginaFinal" => "361"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20224408"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The pathogenesis of pleural space loculation and fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46; Idell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCP.0b013e3282fd0d9b"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Pulm Med"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "310"
                        "paginaFinal" => "315"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18520264"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Single-chain urokinase alone or complexed to its receptor in tetracycline-induced pleuritis in rabbits"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Idell"
                            1 => "A&#46; Mazar"
                            2 => "D&#46; Cines"
                            3 => "A&#46; Kuo"
                            4 => "G&#46; Parry"
                            5 => "S&#46; Gawlak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200204-313OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "166"
                        "paginaInicial" => "920"
                        "paginaFinal" => "926"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12359647"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of complicated pleural effusions in 2013"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Bhatnagar"
                            1 => "N&#46;A&#46; Maskell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ccm.2012.11.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Chest Med"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "47"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23411056"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Parapneumonic effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;W&#46; Light"
                            1 => "W&#46;M&#46; Girard"
                            2 => "S&#46;G&#46; Jenkinson"
                            3 => "R&#46;B&#46; George"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "1980"
                        "volumen" => "69"
                        "paginaInicial" => "507"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7424940"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "BTS guidelines for the management of community acquired pneumonia in adults&#58; update 2009"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;S&#46; Lim"
                            1 => "S&#46;V&#46; Baudouin"
                            2 => "R&#46;C&#46; George"
                            3 => "A&#46;T&#46; Hill"
                            4 => "C&#46; Jamieson"
                            5 => "I&#46; Le Jeune"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2009.113506"
                      "Revista" => array:5 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2009"
                        "volumen" => "64"
                        "numero" => "Suppl&#46; 3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19717706"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of pleural infection in adults&#58; British Thoracic Society pleural disease guideline 2010"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "on behalf of the BTS Pleural Disease Guideline Group"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;E&#46; Davies"
                            1 => "R&#46;J&#46;O&#46; Davies"
                            2 => "C&#46;W&#46;H&#46; Davies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2010"
                        "volumen" => "65"
                        "numero" => "Suppl&#46; 2"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The bacteriology of pleural infection by genetic and standard methods and its mortality significance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46;A&#46; Maskell"
                            1 => "S&#46; Batt"
                            2 => "E&#46;L&#46; Hedley"
                            3 => "C&#46;W&#46; Davies"
                            4 => "S&#46;H&#46; Gillespie"
                            5 => "R&#46;J&#46; Davies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200601-074OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2006"
                        "volumen" => "174"
                        "paginaInicial" => "817"
                        "paginaFinal" => "823"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16840746"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prediction rule to identify low-risk patients with community-acquired pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Fine"
                            1 => "T&#46;E&#46; Auble"
                            2 => "D&#46;M&#46; Yealy"
                            3 => "B&#46;H&#46; Hanusa"
                            4 => "L&#46;A&#46; Weissfeld"
                            5 => "D&#46;E&#46; Singer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199701233360402"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1997"
                        "volumen" => "336"
                        "paginaInicial" => "243"
                        "paginaFinal" => "250"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8995086"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;D&#46; Chalmers"
                            1 => "A&#46; Singanayagam"
                            2 => "M&#46;P&#46; Murray"
                            3 => "C&#46; Scally"
                            4 => "A&#46; Fawzi"
                            5 => "A&#46;T&#46; Hill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2008.105080"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2009"
                        "volumen" => "64"
                        "paginaInicial" => "592"
                        "paginaFinal" => "597"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19131449"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A clinical socre &#40;RAPID&#41; to identify those at risk for poor outcome at presentation in patients with pleural infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46;M&#46; Rahman"
                            1 => "B&#46;C&#46; Kahan"
                            2 => "R&#46;F&#46; Miller"
                            3 => "F&#46;V&#46; Gleeson"
                            4 => "A&#46;J&#46; Nunn"
                            5 => "N&#46;A&#46; Maskell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.13-1558"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2014"
                        "volumen" => "145"
                        "paginaInicial" => "848"
                        "paginaFinal" => "855"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24264558"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic utility and clinical application of imaging for pleural space infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;E&#46; Heffner"
                            1 => "J&#46;S&#46; Klein"
                            2 => "C&#46; Hampson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.08-3002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2010"
                        "volumen" => "137"
                        "paginaInicial" => "467"
                        "paginaFinal" => "479"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20133295"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Differentiating lung abscess and empiema&#58; radiography and computed tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;D&#46; Stark"
                            1 => "M&#46;P&#46; Federle"
                            2 => "P&#46;C&#46; Goodman"
                            3 => "A&#46;E&#46; Podrasky"
                            4 => "W&#46;R&#46; Webb"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Roentgenol"
                        "fecha" => "1983"
                        "volumen" => "141"
                        "paginaInicial" => "163"
                        "paginaFinal" => "167"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The definition and epidemiology of pleural space infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Strange"
                            1 => "S&#46;A&#46; Sahn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Respir Infect"
                        "fecha" => "1999"
                        "volumen" => "14"
                        "paginaInicial" => "3"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10197392"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Streptococcus intermedius</span>&#44; <span class="elsevierStyleItalic">Streptococcus constellatus</span>&#44; and <span class="elsevierStyleItalic">Streptococcus anginosus</span> &#40;the <span class="elsevierStyleItalic">Streptococcus milleri</span> group&#41;&#58; association with different body sites and clinical infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;A&#46; Whiley"
                            1 => "D&#46; Beighton"
                            2 => "T&#46;G&#46; Winstanley"
                            3 => "H&#46;Y&#46; Fraser"
                            4 => "J&#46;M&#46; Hardie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "1992"
                        "volumen" => "30"
                        "paginaInicial" => "243"
                        "paginaFinal" => "244"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1734062"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pleural infection&#58; changing bacteriology and its implications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Lisboa"
                            1 => "G&#46;W&#46; Waterer"
                            2 => "Y&#46;C&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1440-1843.2011.01964.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respirology"
                        "fecha" => "2011"
                        "volumen" => "16"
                        "paginaInicial" => "598"
                        "paginaFinal" => "603"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21382129"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Parapneumonic pleural effusion incidence in a French region before and during the antipneumococcal vaccine era"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Masson"
                            1 => "C&#46; Menetrey"
                            2 => "F&#46; Garnier"
                            3 => "C&#46; Bahans"
                            4 => "A&#46; Fargeot"
                            5 => "M&#46; Layadi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arcped.2011.05.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Pediatr"
                        "fecha" => "2011"
                        "volumen" => "18"
                        "paginaInicial" => "846"
                        "paginaFinal" => "849"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21664805"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interventional management of pleural infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;E&#46; Heffner"
                            1 => "J&#46;S&#46; Klein"
                            2 => "C&#46; Hampson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.08-2956"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2009"
                        "volumen" => "136"
                        "paginaInicial" => "1148"
                        "paginaFinal" => "1159"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19809058"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0505"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What size parapneumonic effusions should be sampled&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46; Skouras"
                            1 => "A&#46; Awdankiewicz"
                            2 => "R&#46;W&#46; Light"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2008.112797"
                      "Revista" => array:5 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2010"
                        "volumen" => "65"
                        "paginaInicial" => "91"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20029043"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0510"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#191;Existe una pleuritis paraneum&#243;nica decapitada"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Cobas-Paz"
                            1 => "M&#46; Botana-Rial"
                            2 => "A&#46; Fern&#225;ndez-Villar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2009.11.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2010"
                        "volumen" => "46"
                        "paginaInicial" => "282"
                        "paginaFinal" => "283"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20092932"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0515"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Medical and surgical treatment of parapneumonic effusions&#46; An evidence-based guideline"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;L&#46; Colice"
                            1 => "A&#46; Curtis"
                            2 => "J&#46; Deslauriers"
                            3 => "J&#46; Heffner"
                            4 => "R&#46; Light"
                            5 => "B&#46; Littenberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2000"
                        "volumen" => "118"
                        "paginaInicial" => "1158"
                        "paginaFinal" => "1171"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11035692"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0520"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinically important factors influencing the diagnostic measurement of pleural fluid pH and glucose"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46;M&#46; Rahman"
                            1 => "E&#46;K&#46; Mishra"
                            2 => "H&#46;E&#46; Davies"
                            3 => "R&#46;J&#46; Davies"
                            4 => "Y&#46;C&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200801-062OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "178"
                        "paginaInicial" => "483"
                        "paginaFinal" => "490"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18556632"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0525"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elevated pleural fluid pH in <span class="elsevierStyleItalic">Proteus mirabilis</span> empyema"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;R&#46; Pine"
                            1 => "J&#46;L&#46; Hollman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1983"
                        "volumen" => "84"
                        "paginaInicial" => "109"
                        "paginaFinal" => "111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6345098"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0530"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pleural fluid parameters identifying complicated parapneumonic effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Jim&#233;nez-Castro"
                            1 => "G&#46; D&#237;az-Nuevo"
                            2 => "A&#46; Sueiro"
                            3 => "A&#46; Muriel"
                            4 => "E&#46; P&#233;rez-Rodr&#237;guez"
                            5 => "R&#46;W&#46; Light"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000086248"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respiration"
                        "fecha" => "2005"
                        "volumen" => "72"
                        "paginaInicial" => "357"
                        "paginaFinal" => "364"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16088277"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0535"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Usefulness of the British Thoracic Society and the American College of Chest Physicians guidelines in predicting pleural drainage of non-purulent parapneumonic effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;M&#46; Porcel"
                            1 => "M&#46; Vives"
                            2 => "A&#46; Esquerda"
                            3 => "A&#46; Ruiz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2005.06.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2006"
                        "volumen" => "100"
                        "paginaInicial" => "933"
                        "paginaFinal" => "937"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16253494"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0540"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pleural fluid C-reactive protein contributes to the diagnosis and assessment of severity of parapneumonic effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;M&#46; Porcel"
                            1 => "S&#46; Bielsa"
                            2 => "A&#46; Esquerda"
                            3 => "A&#46; Ruiz-Gonz&#225;lez"
                            4 => "M&#46; Falguera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejim.2012.03.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Intern Med"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "447"
                        "paginaFinal" => "450"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22726374"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0545"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Biomarkers of infection for the differential diagnosis of pleural effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Porcel"
                            1 => "M&#46; Vives"
                            2 => "G&#46; Cao"
                            3 => "S&#46; Bielsa"
                            4 => "A&#46; Ruiz-Gonz&#225;lez"
                            5 => "A&#46; Mart&#237;nez-Iribarren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00197208"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2009"
                        "volumen" => "34"
                        "paginaInicial" => "1383"
                        "paginaFinal" => "1389"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19541708"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0550"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Procalcitonin&#44; C-reactive protein&#44; and cell counts in the diagnosis of parapneumonic pleural effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;E&#46; San Jos&#233;"
                            1 => "L&#46; Vald&#233;s"
                            2 => "L&#46;H&#46; Vizca&#237;no"
                            3 => "T&#46; Mora"
                            4 => "A&#46; Pose"
                            5 => "E&#46; Soneira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.231/JIM.0b013e3181f88648"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Investig Med"
                        "fecha" => "2010"
                        "volumen" => "58"
                        "paginaInicial" => "971"
                        "paginaFinal" => "976"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20930646"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0555"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic and prognostic values of pleural fluid procalcitonin in parapneumonic pleural effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;C&#46; Lin"
                            1 => "Y&#46;C&#46; Chen"
                            2 => "J&#46;T&#46; Wu"
                            3 => "Y&#46;C&#46; Ko"
                            4 => "C&#46;C&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.08-1134"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2009"
                        "volumen" => "136"
                        "paginaInicial" => "205"
                        "paginaFinal" => "211"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19255287"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0560"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of pleural fluid procalcitonin and C-reactive protein in the diagnosis of parapneumonic pleural effusions&#58; a systemic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Z&#46; Ming-Xiang"
                            1 => "Z&#46; Rong-Rong"
                            2 => "W&#46; Wen-Ju"
                            3 => "Z&#46; Ning-Jie"
                            4 => "L&#46; Wen-En"
                            5 => "F&#46; Xue-Gong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajem.2012.04.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Emerg Med"
                        "fecha" => "2012"
                        "volumen" => "30"
                        "paginaInicial" => "1907"
                        "paginaFinal" => "1914"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22795416"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0565"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ability of procalcitonin to discriminate infection from non-infective inflammation using two pleural disease settings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46;J&#46; McCann"
                            1 => "S&#46;J&#46; Chapman"
                            2 => "W&#46;C&#46; Yu"
                            3 => "N&#46;A&#46; Maskell"
                            4 => "R&#46;J&#46; Davies"
                            5 => "Y&#46;C&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0049894"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "e49894"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23251353"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0570"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumor necrosis factor-&#945; in pleural fluid&#46; A marker of complicated parapneumonic effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Porcel"
                            1 => "M&#46; Vives"
                            2 => "A&#46; Esquerda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2004"
                        "volumen" => "125"
                        "paginaInicial" => "160"
                        "paginaFinal" => "164"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14718436"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0575"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pleural fluid interferon-&#947; and tumour necrosis factor-&#945; in tuberculous and rheumatoid pleurisy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46; Soderblom"
                            1 => "P&#46; Nyberg"
                            2 => "A&#46;M&#46; Teppo"
                            3 => "M&#46; Klockars"
                            4 => "H&#46; Riska"
                            5 => "T&#46; Pettersson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1996"
                        "volumen" => "9"
                        "paginaInicial" => "1652"
                        "paginaFinal" => "1655"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0580"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic value of proinflammatory interleukins in parapneumonic effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1309/AJCPB67PYKVRVPPR"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Pathol"
                        "fecha" => "2010"
                        "volumen" => "133"
                        "paginaInicial" => "884"
                        "paginaFinal" => "891"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0585"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Discrimination of exudative pleural effusions based on multiple biological parameters"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00126306"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2007"
                        "volumen" => "30"
                        "paginaInicial" => "957"
                        "paginaFinal" => "964"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0590"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tumour necrosis factor-a and nitric oxide&#44; determined as nitrite&#44; in malignant pleural effusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "1994"
                        "volumen" => "88"
                        "paginaInicial" => "743"
                        "paginaFinal" => "748"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0595"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pleural fluid interleukin-8 and C-reactive protein for discriminating complicated nonpurulent from uncomplicated parapenumonic effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1440-1843.2007.01189.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respirology"
                        "fecha" => "2008"
                        "volumen" => "13"
                        "paginaInicial" => "58"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0600"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utility of measurement of interleukin-1&#946; and interleukin-8 in the diagnosis of complicated parapneumonic pleural effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1309/AJCPDC7PS8TIPBXP"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Pathol"
                        "fecha" => "2014"
                        "volumen" => "142"
                        "paginaInicial" => "467"
                        "paginaFinal" => "473"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0605"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pleural SC5b-9&#58; a test for identifying complicated parapneumonic effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "29543"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respiration"
                        "fecha" => "2000"
                        "volumen" => "67"
                        "paginaInicial" => "433"
                        "paginaFinal" => "438"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0610"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Polymorphonuclear elastase in the early diagnosis of complicated pyogenic pleural effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "74200"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respiration"
                        "fecha" => "2003"
                        "volumen" => "70"
                        "paginaInicial" => "462"
                        "paginaFinal" => "467"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0615"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pleural-fluid myeloperoxidase in complicated and noncomplicated parapneumonic effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2002"
                        "volumen" => "19"
                        "paginaInicial" => "320"
                        "paginaFinal" => "325"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0620"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pleural infection&#58; what we need to know but don&#8217;t"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCP.0b013e328352c673"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Pulm Med"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "paginaInicial" => "321"
                        "paginaFinal" => "325"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0625"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normativa sobre el diagn&#243;stico y tratamiento del derrame pleural&#46; Actualizaci&#243;n"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2014.01.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2014"
                        "volumen" => "50"
                        "paginaInicial" => "235"
                        "paginaFinal" => "249"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0630"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotic levels in empyemic pleural fluid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2000"
                        "volumen" => "117"
                        "paginaInicial" => "1734"
                        "paginaFinal" => "1739"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0635"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinicoradiographic correlation with the extent of Legionnaire disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Roentgenol"
                        "fecha" => "1983"
                        "volumen" => "141"
                        "paginaInicial" => "263"
                        "paginaFinal" => "268"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0640"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship between chest tube size and clinical outcome in pleural infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.09-1044"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2010"
                        "volumen" => "137"
                        "paginaInicial" => "536"
                        "paginaFinal" => "543"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0645"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point&#58; should fibrinolytics be routinely administered intrapleurally for management of a complicated parapneumonic effusion&#63; Yes&#47;No"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.13-2354"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2014"
                        "volumen" => "145"
                        "paginaInicial" => "14"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0650"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2008"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0655"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrapleural use of tissue plasminogen activator and DNase in pleural infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1012740"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2011"
                        "volumen" => "365"
                        "paginaInicial" => "518"
                        "paginaFinal" => "526"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0660"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intra-pleural fibrinolytic therapy for treatment of adult parapneumonic effusions and empyemas&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.11-3071"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2012"
                        "volumen" => "142"
                        "paginaInicial" => "401"
                        "paginaFinal" => "411"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0665"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomised controlled trial of intrapleural streptokinase in community acquired pleural infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1997"
                        "volumen" => "52"
                        "paginaInicial" => "416"
                        "paginaFinal" => "421"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib0670"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrapleural urokinase versus normal saline in the treatment of complicated parapneumonic effusions and empyema&#46; A randomized&#44; double-blind study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.159.1.9803094"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1999"
                        "volumen" => "159"
                        "paginaInicial" => "37"
                        "paginaFinal" => "42"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib0675"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrapleural urokinase in the management of parapneumonic empyema&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Clin Pract"
                        "fecha" => "2001"
                        "volumen" => "55"
                        "paginaInicial" => "658"
                        "paginaFinal" => "660"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib0680"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A trial of intrapleural streptokinase"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2005"
                        "volumen" => "352"
                        "paginaInicial" => "2243"
                        "paginaFinal" => "2245"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib0685"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early use of intrapleural fibrinolytics in the management of postpneumonic empyema&#46; A prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2005.07.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2005"
                        "volumen" => "28"
                        "paginaInicial" => "599"
                        "paginaFinal" => "603"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            67 => array:3 [
              "identificador" => "bib0690"
              "etiqueta" => "68"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Video-assistedthoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas&#58; outcome of 234 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.127.4.1427"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2005"
                        "volumen" => "127"
                        "paginaInicial" => "1427"
                        "paginaFinal" => "1432"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            68 => array:3 [
              "identificador" => "bib0695"
              "etiqueta" => "69"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The diminishing role of surgery in pleural disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCP.0b013e3283474121"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Pulm Med"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "247"
                        "paginaFinal" => "254"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            69 => array:3 [
              "identificador" => "bib0700"
              "etiqueta" => "70"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1510/icvts.2010.240408"
                      "Revista" => array:6 [
                        "tituloSerie" => "Interact Cardiovasc Thorac Surg"
                        "fecha" => "2010"
                        "volumen" => "11"
                        "paginaInicial" => "171"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000005100000012/v1_201512080104/S1579212915003158/v1_201512080104/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "46448"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Review Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000012/v1_201512080104/S1579212915003158/v1_201512080104/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915003158?idApp=UINPBA00003Z"
]

Article information

ISSN: 15792129
Original language: English

DOI:10.1016/j.arbr.2015.10.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	27	6	33
2024 October	328	109	437
2024 September	469	134	603
2024 August	349	138	487
2024 July	353	99	452
2024 June	259	85	344
2024 May	293	83	376
2024 April	149	93	242
2024 March	198	55	253
2024 February	134	44	178
2024 January	3	1	4
2023 November	1	3	4
2023 September	1	0	1
2023 May	1	0	1
2023 March	91	11	102
2023 February	575	130	705
2023 January	529	106	635
2022 December	583	96	679
2022 November	672	0	672
2022 October	714	109	823
2022 September	642	139	781
2022 August	588	135	723
2022 July	477	123	600
2022 June	583	125	708
2022 May	559	146	705
2022 April	703	142	845
2022 March	859	193	1052
2022 February	790	147	937
2022 January	662	128	790
2021 December	449	153	602
2021 November	475	148	623
2021 October	485	156	641
2021 September	406	140	546
2021 August	362	139	501
2021 July	423	185	608
2021 June	441	140	581
2021 May	662	149	811
2021 April	1147	335	1482
2021 March	706	177	883
2021 February	502	140	642
2021 January	480	120	600
2020 December	465	107	572
2020 November	519	162	681
2020 October	471	163	634
2020 September	532	134	666
2020 August	404	130	534
2020 July	598	151	749
2020 June	504	153	657
2020 May	356	147	503
2020 April	302	145	447
2020 March	366	137	503
2020 February	383	172	555
2020 January	296	147	443
2019 December	370	115	485
2019 November	358	140	498
2019 October	367	191	558
2019 September	328	202	530
2019 August	213	143	356
2019 July	231	117	348
2019 June	372	139	511
2019 May	596	135	731
2019 April	306	108	414
2019 March	255	97	352
2019 February	196	82	278
2019 January	179	75	254
2018 December	169	61	230
2018 November	201	83	284
2018 October	258	90	348
2018 September	243	77	320
2018 May	140	5	145
2018 April	238	15	253
2018 March	171	17	188
2018 February	145	16	161
2018 January	158	22	180
2017 December	147	20	167
2017 November	168	10	178
2017 October	182	20	202
2017 September	138	41	179
2017 August	162	46	208
2017 July	170	46	216
2017 June	145	41	186
2017 May	158	50	208
2017 April	124	52	176
2017 March	135	46	181
2017 February	186	35	221
2017 January	88	31	119
2016 December	77	36	113
2016 November	104	41	145
2016 October	124	52	176
2016 September	196	49	245
2016 August	73	20	93
2016 July	54	42	96

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter