Introduction
pleural infections, Sepsis, empyemas
PARAPNEUMONIC EFFUSION, CAVITY, SEPSIS, PLEURAL INFECTION
Complicated pleural infections (CPIs), including complicated parapneumonic effusions and empyemas, are common, affecting approximately 80 000 patients each year in the US and United Kingdom combined.Initial treatment of CPI requires antibiotic therapy and drainage; however, more aggressive management is often required. Next management steps include surgery or intrapleural fibrinolytic therapy (IPFT) with tissue plasminogen activator and deoxyribonuclease. There is a paucity of evidence directly comparing the efficacy and outcomes of IPFT management with surgery, and most published studies have significant methodological weaknesses. This lack of evidence leads to challenging decision-making for clinicians. Even though the Multicenter Intrapleural Sepsis Trial (MIST II) demonstrated IPFT to be an effective treatment more than a decade ago,High-quality, adequately powered prospective randomized clinical trials are needed to definitively compare these 2 management strategies and guide clinical decision-making. This pilot study of CPI management compared chest tube drainage of the pleural cavity using IPFT and surgical decortication with the intent to inform on the study algorithm and end point performance in anticipation of a multicenter randomized clinical trial.