In this debate, the question involves three key terms: fibrinolytics, routine administration intrapleurally, and complicated parapneumonic effusion (PPE). Fibrinolytics promote lysis of fibrin by generating plasmin. The only currently available fibrinolytic in the United States is tissue plasminogen activator (tPA). Routine use implies that administration of intrapleural fibrinolytic therapy represents a standard approach. Complicated PPE is a term introduced by Light1 to describe a PPE that evolved into the fibropurulent stage with a higher pleural fluid lactate dehydrogenase level, a lower pleural fluid glucose level, and a higher likelihood of a positive pleural fluid Gram stain. Light1 suggested that complicated PPE would not resolve with antibiotic treatment but would require drainage. Instead of the term complicated PPE, we prefer the approach adopted by the American College of Chest Physicians consensus panel for the management of PPE for identifying those PPEs in need of effective drainage.2 This consensus panel divided PPE into four different groups with varying risks for poor outcomes based on pleural space anatomy, pleural fluid bacteriology, and pleural fluid chemistry criteria (Table 1). The groups at increased risk for poor outcomes, such as those with large or loculated effusions, empyema, or a pleural fluid pH < 7.20, would benefit from drainage.