A Retrospective Cohort Study Evaluating the Safety and Efficacy of Sequential versus Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection
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...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Hindawi Limited
2023-01-01
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| Series: | Pulmonary Medicine |
| Online Access: | http://dx.doi.org/10.1155/2023/6340851 |
| _version_ | 1797376459068669952 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Ken Junyang Goh |
| collection | DOAJ |
| description | 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 (p=0.534). This translates to a treatment success rate of 90.5% and 94.1% for sequential and concurrent intrapleural therapy, respectively. There was no significant difference in the decrease in percentage of pleural effusion size on chest radiographs (15.1% [IQR 6-35.7] versus 26.6% [IQR 9.9-38.7], p=0.143) between sequential and concurrent therapy, respectively. There were also no significant differences in the rate of pleural bleeding (4.8% versus 9.8%, p=0.298) and chest pain (13.1% versus 9.8%, p=0.566) between sequential and concurrent therapy, respectively. Conclusion. Our study adds to the growing literature on the safety and efficacy of concurrent intrapleural therapy in pleural infection. |
| first_indexed | 2024-03-08T19:38:58Z |
| format | Article |
| id | doaj.art-f4e667779b964c1f863ba27554214e1d |
| institution | Directory Open Access Journal |
| issn | 2090-1844 |
| language | English |
| last_indexed | 2024-03-08T19:38:58Z |
| publishDate | 2023-01-01 |
| publisher | Hindawi Limited |
| record_format | Article |
| series | Pulmonary Medicine |
| spelling | doaj.art-f4e667779b964c1f863ba27554214e1d2023-12-26T00:00:02ZengHindawi LimitedPulmonary Medicine2090-18442023-01-01202310.1155/2023/6340851A Retrospective Cohort Study Evaluating the Safety and Efficacy of Sequential versus Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural InfectionKen Junyang Goh0Wui Mei Chew1Jasmine Chiat Ling Ong2Carrie Kah-Lai Leong3Imran Bin Mohamed Noor4Devanand Anantham5Li Yan Sandra Hui6Mindy Chu Ming Choong7Charlene Jin Yee Liew8Marnie Tamayo Gutierrez9Jane Jing Yi Wong10Ivana Gilcrist Chiew Sian Phua11Wen Ting Lim12Qiao Li Tan13Department of Respiratory and Critical Care MedicineDepartment of Respiratory and Critical Care MedicineDivision of PharmacyDepartment of Respiratory and Critical Care MedicineDepartment of Respiratory and Critical Care MedicineDepartment of Respiratory and Critical Care MedicineDepartment of Respiratory and Critical Care MedicineDepartment of Diagnostic RadiologyDepartment of Diagnostic RadiologyAdvanced Practice Nurse DevelopmentDivision of NursingDivision of NursingDivision of NursingDepartment of Respiratory and Critical Care MedicineBackground 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 (p=0.534). This translates to a treatment success rate of 90.5% and 94.1% for sequential and concurrent intrapleural therapy, respectively. There was no significant difference in the decrease in percentage of pleural effusion size on chest radiographs (15.1% [IQR 6-35.7] versus 26.6% [IQR 9.9-38.7], p=0.143) between sequential and concurrent therapy, respectively. There were also no significant differences in the rate of pleural bleeding (4.8% versus 9.8%, p=0.298) and chest pain (13.1% versus 9.8%, p=0.566) between sequential and concurrent therapy, respectively. Conclusion. Our study adds to the growing literature on the safety and efficacy of concurrent intrapleural therapy in pleural infection.http://dx.doi.org/10.1155/2023/6340851 |
| spellingShingle | 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 A Retrospective Cohort Study Evaluating the Safety and Efficacy of Sequential versus Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection Pulmonary Medicine |
| title | A Retrospective Cohort Study Evaluating the Safety and Efficacy of Sequential versus Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection |
| title_full | A Retrospective Cohort Study Evaluating the Safety and Efficacy of Sequential versus Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection |
| title_fullStr | A Retrospective Cohort Study Evaluating the Safety and Efficacy of Sequential versus Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection |
| title_full_unstemmed | A Retrospective Cohort Study Evaluating the Safety and Efficacy of Sequential versus Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection |
| title_short | A Retrospective Cohort Study Evaluating the Safety and Efficacy of Sequential versus Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection |
| title_sort | retrospective cohort study evaluating the safety and efficacy of sequential versus concurrent intrapleural instillation of tissue plasminogen activator and dnase for pleural infection |
| url | http://dx.doi.org/10.1155/2023/6340851 |
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