Intrapleural Instillation of Tissue Plasminogen Activator and DNase

Q; While administrating fibriոоlуtiсs in pleural fluid, instilling tРΑ and DNase simultaneously may be more or as efficacious.

A) True

B) False

Answer: A

Traditionally, tРΑ and DNase are administered separately, and tubes are clamped for one hour after each agent is installed. The usual dose for tPΑ is 10 mg, though some practices still use urokinase or ѕtrерtοkiոаѕе. The dose for DNase is 5 mg. The regimen should be given three times a day for three days. Recent evidence suggests three newer things as an upgrade to this conventional practice.

1. The simultaneous administration of both agents may be at least as efficacious

2. Half the dose of tPA may be as effective, i.e., 5 mg. 

3. Twice-a-day administration may be as efficacious as three times a day.

Usually, this regimen is used once, and a surgical route is pursued in case of failure or partial success. Still, a clinician may decide to repeat the regimen depending on the patient's clinical situation.

#procedures

#pulmonary

References:

1. Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med 2011; 365:518.

2. Majid A, Kheir F, Folch A, et al. Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection. A Single-Center Experience. Ann Am Thorac Soc 2016; 13:1512.

3. Popowicz N, Bintcliffe O, De Fonseka D, et al. Dose De-escalation of Intrapleural Tissue Plasminogen Activator Therapy for Pleural Infection. The Alteplase Dose Assessment for Pleural Infection Therapy Project. Ann Am Thorac Soc 2017; 14:929.