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

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 use...

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Autores principales: Cheong, Xiong Khee, Ban, Andrea Yu-Lin, Ng, Boon Hau, Nik Abeed, Nik Nuratiqah, Nik Ismail, Nik Azuan, Nik Fuad, Nik Farhan, Syed Zakaria, Syed Zulkifli, Ghan, Sheah Lin, Abdul Hamid, Mohamed Faisal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9115979/
https://www.ncbi.nlm.nih.gov/pubmed/35581627
http://dx.doi.org/10.1186/s12890-022-01995-z
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author Cheong, Xiong Khee
Ban, Andrea Yu-Lin
Ng, Boon Hau
Nik Abeed, Nik Nuratiqah
Nik Ismail, Nik Azuan
Nik Fuad, Nik Farhan
Syed Zakaria, Syed Zulkifli
Ghan, Sheah Lin
Abdul Hamid, Mohamed Faisal
author_facet Cheong, Xiong Khee
Ban, Andrea Yu-Lin
Ng, Boon Hau
Nik Abeed, Nik Nuratiqah
Nik Ismail, Nik Azuan
Nik Fuad, Nik Farhan
Syed Zakaria, Syed Zulkifli
Ghan, Sheah Lin
Abdul Hamid, Mohamed Faisal
author_sort Cheong, Xiong Khee
collection PubMed
description 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). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-022-01995-z.
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spelling pubmed-91159792022-05-19 Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience Cheong, Xiong Khee Ban, Andrea Yu-Lin Ng, Boon Hau Nik Abeed, Nik Nuratiqah Nik Ismail, Nik Azuan Nik Fuad, Nik Farhan Syed Zakaria, Syed Zulkifli Ghan, Sheah Lin Abdul Hamid, Mohamed Faisal BMC Pulm Med Research 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). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-022-01995-z. BioMed Central 2022-05-17 /pmc/articles/PMC9115979/ /pubmed/35581627 http://dx.doi.org/10.1186/s12890-022-01995-z Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Cheong, Xiong Khee
Ban, Andrea Yu-Lin
Ng, Boon Hau
Nik Abeed, Nik Nuratiqah
Nik Ismail, Nik Azuan
Nik Fuad, Nik Farhan
Syed Zakaria, Syed Zulkifli
Ghan, Sheah Lin
Abdul Hamid, Mohamed Faisal
Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience
title Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience
title_full Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience
title_fullStr Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience
title_full_unstemmed Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience
title_short Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience
title_sort modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9115979/
https://www.ncbi.nlm.nih.gov/pubmed/35581627
http://dx.doi.org/10.1186/s12890-022-01995-z
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