A Retrospective Cohort Study Evaluating the Safety and Efficacy of Sequential versus Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection
Ken Junyang Goh, Wui Mei Chew, Jasmine Chiat Ling Ong, Carrie Kah-Lai Leong, Imran Bin Mohamed Noor, Devanand Anantham, Li Yan Sandra Hui, Mindy Chu Ming Choong, Charlene Jin Yee Liew, Marnie Tamayo Gutierrez, Jane Jing Yi Wong, Ivana Gilcrist Chiew Sian Phua, Wen Ting Lim, Qiao Li Tan- Pulmonary and Respiratory Medicine
- General Medicine
Background and Objective. Intrapleural tissue plasminogen activator/deoxyribonuclease (tPA/DNase) is increasingly being used for pleural infections. Compared to sequential instillation of tPA/DNase, concurrent instillation considerably reduces the complexity of the administration process and reduces workload and the number of times the chest drain is accessed. However, it remains unclear if concurrent intrapleural therapy is as efficacious or safe as sequential intrapleural therapy. Methods. We conducted a retrospective review of patients with pleural infection requiring intrapleural therapy at two tertiary referral centres. Results. We included 84 (62.2%) and 51 (37.8%) patients who received sequential and concurrent intrapleural therapy, respectively. Patient demographics and clinical characteristics, including age, RAPID score, and percentage of pleural opacity on radiographs before intrapleural therapy, were similar in both groups. Treatment failure rates (defined by either in-hospital mortality, surgical intervention, or 30-day readmission for pleural infection) were 9.5% and 5.9% with sequential and concurrent intrapleural therapy, respectively (