Efficacy of Non-instrumental Pleural Chest Physiotherapy

Inclusion Criteria:

• ≥ eighteen years old

• to be hospitalized for an infectious pleural outpouring

• to have a liquid pleural outpouring diagnosed by echography or to scan thoracic

• presence of a Exudate according to the criteria of Light, to have at least criteria:

• The ratio of pleural fluid protein to serum protein is greater than 0.5

• The ratio of pleural fluid Lactate dehydrogenase (LDH) and serum LDH is greaterthan 0.6

• The rate of pleural fluid LDH is > 2/3 upper limit of normal serum LDH of thelaboratory concerned

• presence of at least two of the following criteria:

• fever higher or equal 38°C (100.4°F)

• thoracic pain

• purulent sputum

• purulent pleural effusion at the time of the exploring pleural puncture

• hearth of crackling to the sounding

• Inflammatory syndrome (CRP>15 mg/l and/or White blood cell >10 000 /mm3)

• no known radiological hearth before

• Having undergone an evacuation gesture going back to less forty-eight hours:evacuation pleural puncture or repeated pleural punctures or pleural drainageallowing the evacuation of at least 100cc of pleural fluid

• Informed and having given its free, lit and express assent

• Patients with affiliation to the social security system

Exclusion Criteria:

• Patient having undergone a thoracotomy or thoracoscopy in the six previous months

• Patient having a pneumothorax

• Patient reached of a tuberculosis

• Patient unable to carry out a measurement of the vital capacity by portablespirometer at the inclusion

• Pregnant woman or nursing

• Patient having a life expectancy lower than three months

• Proven or suspected pleural neoplasia disease

• Patient hemodynamically unstable

• Patient having a respiratory insufficiency requiring the introduction of anartificial ventilation

• Patient carrying a chronic respiratory insufficiency under non-invasive ventilationwith the long course

• Patient unable to carry out the exercises of physiotherapy (problem of communicationand/or comprehension and/or physical inaptitude)

• Patient transplanted of a solid body, allograft or autograft of hematopoietic stemcells

• Patient with a seropositivity for the known HIV and cluster of differentiation 4 (CD4) <250/mm3