title: Safety and Efficacy of Intrapleural Tissue Plasminogen Activator and DNase during Extended Use in Complicated Pleural Space Infections.
abstract: The use of intrapleural therapy with tissue plasminogen activator and DNase improves outcomes in patients with complicated pleural space infections. However, little data exists for the use of combination intrapleural therapy after the initial dosing period of six doses. We sought to describe the safety profile and outcomes of intrapleural therapy beyond this standard dosing. A retrospective review of patients receiving intrapleural therapy with tissue plasminogen activator and DNase was performed at two institutions. We identified 101 patients from January 2013 to August 2015 receiving intrapleural therapy for complicated pleural space infection. The extended use of intrapleural tissue plasminogen activator and DNase therapy beyond six doses was utilized in 20% (20/101) of patients. The mean number of doses in those undergoing extended dosing was 9.8 (range of 7-16). Within the population studied there appears to be no statistically significant increased risk of complications, need for surgical referral, or outcome differences when comparing those receiving standard or extended dosing intrapleural therapy. Future prospective study of intrapleural therapy as an alternative option for patients who fail initial pleural drainage and are unable to tolerate/accept a surgical intervention appears a potential area of study.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
authors.forename: Jason R
authors.initials: JR
authors.lastname: McClune
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute and Medical Center, Seattle, WA 98104, USA.
authors.forename: Candice L
authors.initials: CL
authors.lastname: Wilshire
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute and Medical Center, Seattle, WA 98104, USA.
authors.forename: Jed A
authors.initials: JA
authors.lastname: Gorden
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute and Medical Center, Seattle, WA 98104, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Louie
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute and Medical Center, Seattle, WA 98104, USA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Farviar
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stefanski
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute and Medical Center, Seattle, WA 98104, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Vallieres
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute and Medical Center, Seattle, WA 98104, USA.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Aye
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute and Medical Center, Seattle, WA 98104, USA.
authors.forename: Christopher R
authors.identifier: 0000-0003-3868-4578
authors.initials: CR
authors.lastname: Gilbert
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D015505:Chest Tubes; D003851:Deoxyribonucleases / Q000008:administration & dosage*; D016724:Empyema, Pleural / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013907:Thoracostomy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D005343:Fibrinolytic Agents; D003851:Deoxyribonucleases; D010959:Tissue Plasminogen Activator