Retrospective review of intrapleural therapy for pleural infections: "Real life" outcomes and challenges. Issue 4 (2nd October 2018) - Robitaille, Catherine
Abstract: RATIONALE: The mainstay of treatment for pleural infections includes antibiotics, chest tube drainage and intrapleural fibrinolytics (tPA) and mucolytics (DNase). We aimed to review the outcomes of patients treated with intrapleural therapy for pleural infection at our institution. METHODS: We conducted a single-center retrospective review of adults who received intrapleural tPA/DNase for a pleural infection from 2013 to 2016. Cases were identified through the pharmacy database. RESULTS: A total of 109 patients were eligible for analysis. Treatment with tPA/DNase was successful in 85 patients (78.0%), using the composite outcome of survival to hospital discharge without the need for surgery. Median length of stay, from first dose of tPA/DNase to discharge (or death), was 10.5 days. The rate of surgical intervention was 13.8% and intrahospital mortality was 11.0%. Additionally, the mean delay from the detection of effusion to chest drain insertion was 3.5 days and the mean delay from chest drain insertion to the initial dose of tPA/DNase was 5.0 days. Insertion of a second chest drain was needed in 61.5% of patients, most commonly for upsizing. A low proportion of patients (25.3%) benefited from a complete first cycle course of intrapleural therapy. At least one serious adverse event related to tPA/DNase therapy happened in 13.5% of patients. CONCLUSION: In this retrospective study, outcomes of intrapleural tPA/DNase for pleural infections were less favorable than previously reported. Delays at various steps in the management, suboptimal adherence to treatment and complications were identified. These issues are currently being targeted with quality improvement initiatives.