Intrapleural agents for pleural infection: fibrinolytics and beyond
Current Opinion in Pulmonary Medicine, 06/04/2012
Rahman NM – Fibrinolytic therapy alone has not been proven to be of use in the treatment of pleural infection. The Multi–Centre Intrapleural Sepsis Trial 2 (MIST2) study provides clear–cut evidence demonstrating improved chest radiographs, and highly suggestive secondary outcomes suggesting improved clinically important outcomes, using a combination of intrapleural tPA and DNase. This novel treatment combination may represent an important step in the understanding and treatment of pleural infection; however, larger clinical studies specifically addressing important clinical outcomes and further laboratory research describing the potential mechanisms of action are now required.