Intrapleural Fibrinolytic Therapy versus Early Medical Thoracoscopy for Treatment of Pleural Infection. Randomized Controlled Clinical Trial

• Published in: Annals of the American Thoracic Society Vol. 17; no. 8; pp. 958 - 964
• Main Authors: Kheir, Fayez, Thakore, Sanket, Mehta, Hiren, Jantz, Michael, Parikh, Mihir, Chee, Alex, Kaphle, Upendra, Sisnega, Carlos, Fernandez-Bussy, Sebastian, Majid, Adnan
• Format: Journal Article
• Language: English
• Published: New York American Thoracic Society 01-08-2020
• Subjects: Clinical outcomes; Clinical trials; Infections; Pleural effusion; Thoracentesis
• ISSN: 2329-6933; 2325-6621
• DOI: 10.1513/AnnalsATS.202001-076OC

Pleural infection is frequently encountered in clinical practice and is associated with high morbidity and mortality. Limited evidence exists regarding the optimal treatment. Although both early medical thoracoscopy (MT) and tube thoracostomy with intrapleural instillation of tissue plasminogen activator and human recombinant deoxyribonuclease are acceptable treatments for patients with complicated pleural infection, there is a lack of comparative data for these modes of management. The aim of this study was to compare the safety and efficacy of early MT versus intrapleural fibrinolytic therapy (IPFT) in selected patients with multiloculated pleural infection and empyema. This was a prospective multicenter, randomized controlled trial involving patients who underwent MT or IPFT for pleural infection. The primary outcome was the length of hospital stay after either intervention. Secondary outcomes included the total length of hospital stay, treatment failure, 30-day mortality, and adverse events.