BACKGROUND: Intrapleural recombinant tissue plasminogen activator (r-TPA) has been successfully evaluated in pediatric patients with complicated parapneumonic pleural effusion (CPE) and pleural empyema (PE). Yet, there is no data concerning r-TPA in adults with CPE/PE. The aim of our study was to investigate the efficacy and complications of r-TPA in adult patients with CPE/PE. METHODS: Twenty consecutive patients (mean age 50+/-18.9 years) with pleural infection (14 CPE and 6 PE) were included. Chest tube was inserted under guidance of chest ultrasound and/or computed tomography. After failure of pleural fluid drainage, 25mg of r-TPA was administered intrapleurally in a single daily dose. The evaluation was made according to imaging and clinical status. RESULTS: The mean volume of fluid increased significantly after r-TPA administration (p<0.0001). White blood cells count (WBC) and C-reactive protein (CRP) were significantly improved after r-TPA instillations (both p<0.0001). Significant clinical and imaging improvement was noted in all but one patient after r-TPA administration (overall p<0.0001). Complications observed were mild: pain in 4 (25%) and local bleeding in 3 (15%) patients. The median number of r-TPA instillations was 3 (range 2-5). CONCLUSION: Intrapleural instillation of r-TPA at a dose of 25 mg is a well-tolerated and effective treatment in 95% of our adult patients with CPE/PE.
BACKGROUND: Intrapleural recombinant tissue plasminogen activator (r-TPA) has been successfully evaluated in pediatric patients with complicated parapneumonic pleural effusion (CPE) and pleural empyema (PE). Yet, there is no data concerning r-TPA in adults with CPE/PE. The aim of our study was to investigate the efficacy and complications of r-TPA in adult patients with CPE/PE. METHODS: Twenty consecutive patients (mean age 50+/-18.9 years) with pleural infection (14 CPE and 6 PE) were included. Chest tube was inserted under guidance of chest ultrasound and/or computed tomography. After failure of pleural fluid drainage, 25mg of r-TPA was administered intrapleurally in a single daily dose. The evaluation was made according to imaging and clinical status. RESULTS: The mean volume of fluid increased significantly after r-TPA administration (p<0.0001). White blood cells count (WBC) and C-reactive protein (CRP) were significantly improved after r-TPA instillations (both p<0.0001). Significant clinical and imaging improvement was noted in all but one patient after r-TPA administration (overall p<0.0001). Complications observed were mild: pain in 4 (25%) and local bleeding in 3 (15%) patients. The median number of r-TPA instillations was 3 (range 2-5). CONCLUSION: Intrapleural instillation of r-TPA at a dose of 25 mg is a well-tolerated and effective treatment in 95% of our adult patients with CPE/PE.
Authors: Andrey A Komissarov; Galina Florova; Ali O Azghani; Ann Buchanan; William M Bradley; Chris Schaefer; Kathleen Koenig; Steven Idell Journal: Am J Physiol Lung Cell Mol Physiol Date: 2015-07-10 Impact factor: 5.464
Authors: Tamsin N Cargill; Maged Hassan; John P Corcoran; Elinor Harriss; Rachelle Asciak; Rachel M Mercer; David J McCracken; Eihab O Bedawi; Najib M Rahman Journal: Eur Respir J Date: 2019-10-01 Impact factor: 16.671
Authors: Saleh Abu-Daff; Donna E Maziak; Derar Alshehab; Jennifer Threader; Jelena Ivanovic; Valerie Deslaurier; Patrick-James Villeneuve; Sebastian Gilbert; Sudhir Sundaresan; Farid Shamji; Colleen Lougheed; Jean M Seely; Andrew J E Seely Journal: BMJ Open Date: 2013-01-31 Impact factor: 2.692