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Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience.


ABSTRACT:

Background

Current management of poorly draining complex effusions favours less invasive image-guided placement of smaller tubes and adjunctive intrapleural fibrinolysis therapy (IPFT). In MIST-2 trial, intrapleural 10 mg alteplase (t-PA) with 5 mg of pulmozyme (DNase) twice daily for 72 h were used. We aimed to assess the effectiveness and safety of a modified regimen 16 mg t-PA with 5 mg of DNase administered over 24 h in the management of complex pleural infection.

Methods

This was a single centre, prospective study involving patients with poorly drained pleural infection. Primary outcome was the change of pleural opacity on chest radiograph at day 7 compared to baseline. Secondary outcomes include volume of fluid drained, inflammatory markers improvement, surgical referral, length of hospitalisation, and adverse events.

Results

Thirty patients were recruited. Majority, 27 (90%) patients were successfully treated. Improvement of pleural opacity on chest radiograph was observed from 36.9% [Interquartile range (IQR 21.8-54.9%)] to 18.1% (IQR 8.8-32.7%) of hemithorax (P < 0.05). T-PA/DNase increased fluid drainage from median of 45 mls (IQR 0-100) 24 h prior to intrapleural treatment to 1442 mls (IQR 905-2360) after 72 h; (P < 0.05) and reduction of C-reactive protein (P < 0.05). Pain requiring escalation of analgesia affected 20% patients and 9.9% experienced major adverse events. None required surgical intervention.

Conclusion

This study suggests that a modified regimen 16 mg t-PA with 5 mg DNase can be safe and effective for patients with poorly drained complex pleural infection. Trial registration The study was registered retrospectively on 07/06/2021 with ClinicalTrials number NCT04915586 ( https://clinicaltrials.gov/ct2/show/NCT04915586 ).

SUBMITTER: Cheong XK 

PROVIDER: S-EPMC9115979 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience.

Cheong Xiong Khee XK   Ban Andrea Yu-Lin AY   Ng Boon Hau BH   Nik Abeed Nik Nuratiqah NN   Nik Ismail Nik Azuan NA   Nik Fuad Nik Farhan NF   Syed Zakaria Syed Zulkifli SZ   Ghan Sheah Lin SL   Abdul Hamid Mohamed Faisal MF  

BMC pulmonary medicine 20220517 1


<h4>Background</h4>Current management of poorly draining complex effusions favours less invasive image-guided placement of smaller tubes and adjunctive intrapleural fibrinolysis therapy (IPFT). In MIST-2 trial, intrapleural 10 mg alteplase (t-PA) with 5 mg of pulmozyme (DNase) twice daily for 72 h were used. We aimed to assess the effectiveness and safety of a modified regimen 16 mg t-PA with 5 mg of DNase administered over 24 h in the management of complex pleural infection.<h4>Methods</h4>This  ...[more]

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