TERAPIA FIBRINOLÍTICA INTRAPLEURAL (TFI) NO DERRAME PLEURAL PARAPNEUMÔNICO: EVIDÊNCIAS ATUAIS E APLICAÇÕES CLÍNICAS

Parapneumonic pleural effusion, a common complication of bacterial pneumonia, is characterized by the formation of loculations/fibrin strands, making pleural drainage and infection control more challenging. Intrapleural fibrinolytic therapy (IFT) emerges as a promising therapeutic alternative, reducing the need for invasive surgical interventions. This study reviewed the available evidence on the use of IFT in managing this condition, focusing on its efficacy, safety, and limitations. A narrative literature review was conducted based on the research question: "In patients with pneumonia complicated by pleural effusion, is intrapleural fibrinolytic therapy more effective than other approaches in accelerating effusion resolution and preventing surgical interventions?" The search was carried out in the PubMed, SciELO, and Cochrane Library databases, using descriptors related to pneumonia, pleural effusion, and fibrinolytics, with Boolean operators applied for advanced searches. The inclusion criteria encompassed clinical studies, systematic reviews, and meta-analyses published in the last 10 years that described therapeutic protocols and relevant clinical outcomes. After applying the inclusion and exclusion criteria, 12 articles were selected and analyzed. The results were organized into thematic categories, allowing a critical assessment of the applicability and effectiveness of IFT. It was concluded that, although promising, IFT requires individualized treatment and greater standardization in clinical protocols, highlighting the need for future studies to refine its guidelines.