What This Study Adds to the Field
Pleural Infection, Sepsis
PLEURAL INFECTION, SEPSIS, PLEURAL INFECTION, PLEURAL INFECTION
This is the first multicenter randomized controlled trial of early intrapleural enzyme therapy versus early surgery in pleural infection. It demonstrates that a definitive trial is feasible, identifies interesting signals of potential advantages of early treatment using each modality, and provides valuable insight into the complexities of trial design in this area for future studies.Pleural infection affects an estimated 80,000 patients annually in the United States and United Kingdom combined (The largest international multicenter prospective observational study to date Pleural Infection Longitudinal OuTcome (PILOT [Minimally invasive surgical techniques using video-assisted thoracoscopic surgery (VATS) have potentially widened the population suitable for surgical intervention. However, large case series (Since the publication of the MIST-2 (second Multicenter Intrapleural Sepsis Trial) study, the use of IET has revolutionized medical management. Although MIST-2 was limited by a small number of patients in the IET arm (Thus, both surgery and IET appear to be effective interventions, and early introduction in treatment may improve outcomes. Direct comparison of early VATS and IET requires a phase III RCT; no such study has been conducted to date. The MIST-3 study was designed to assess the feasibility of early randomization to a surgical versus nonsurgical (i.e., IET) intervention and to specifically address the selection bias of previous studies (