Intrapleural Fibrinolytics and Deoxyribonuclease for Treatment of Indwelling Pleural Catheter-Related Pleural Infection: A Multi-Center Observational Study

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Deirdre B. Fitzgerald ◽  
Sanjeevan Muruganandan ◽  
Selina Tsim ◽  
Hugh Ip ◽  
Rachelle Asciak ◽  
...  
Keyword(s):  
Post Infection ◽  
Thoracoscopic Surgery ◽  
Major Morbidity ◽  
Indwelling Pleural Catheter ◽  
Tissue Plasminogen ◽  
Pleural Infection ◽  
Malignant Effusions ◽  
The Mean ◽  
Pleural Catheter ◽  
Gram Negative Organisms

<b><i>Background:</i></b> Indwelling pleural catheters (IPC) are increasingly used for management of recurrent (especially malignant) effusions. Pleural infection associated with IPC use remains a concern. Intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) significantly reduces surgical referrals in non-IPC pleural infection, but data on its use in IPC-related pleural infection are scarce. <b><i>Objective:</i></b> To assess the safety and efficacy of intrapleural tPA and DNase in IPC-related pleural infection. <b><i>Methods:</i></b> Patients with IPC-related pleural infection who received intrapleural tPA/DNase in five Australian and UK centers were identified from prospective databases. Outcomes on <i>feasibility</i> of intrapleural tPA/DNase delivery, its <i>efficacy</i> and <i>safety</i> were recorded. <b><i>Results:</i></b> Thirty-nine IPC-related pleural infections (predominantly <i>Staphylococcus aureus</i> and gram-negative organisms) were treated in 38 patients; 87% had malignant effusions. In total, 195 doses (median 6 [IQR = 3–6]/patient) of tPA (2.5 mg–10 mg) and DNase (5 mg) were instilled. Most (94%) doses were delivered via IPCs using local protocols for non-IPC pleural infections. The mean volume of pleural fluid drained during the first 72 h of treatment was 3,073 (SD = 1,685) mL. Most (82%) patients were successfully treated and survived to hospital discharge without surgery; 7 required additional chest tubes or therapeutic aspiration. Three patients required thoracoscopic surgery. Pleurodesis developed post-infection in 23/32 of successfully treated patients. No major morbidity/mortality was associated with tPA/DNase. Four patients received blood transfusions; none had systemic or significant pleural bleeding. <b><i>Conclusion:</i></b> Treatment of IPC-related pleural infection with intrapleural tPA/DNase instillations via the IPC appears feasible and safe, usually without additional drainage procedures or surgery. Pleurodesis post-infection is common.

Successful treatment of a complex malignant pleural effusion with 1 mg alteplase instilled through a non-draining indwelling pleural catheter

2021 ◽  
Vol 14 (2) ◽  
pp. e236116
Author(s):  
Nik Nuratiqah Nik Abeed ◽  
Mohamed Faisal ◽  
Boon Hau Ng ◽  
Andrea Ban Yu-Lin
Keyword(s):  
Single Dose ◽  
Pleural Effusion ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Malignant Pleural Effusion ◽  
Recombinant Tissue Plasminogen Activator ◽  
Indwelling Pleural Catheter ◽  
Catheter Malfunction ◽  
Tissue Plasminogen ◽  
Pleural Catheter

Indwelling pleural catheter (IPC) is the treatment of choice in managing symptomatic recurrent malignant pleural effusion (MPE). Loculated effusions following insertion may occur due to infection, catheter malfunction or the inflammatory nature of MPE. Loculations may lead to ineffective drainage and make the IPC non-functional. We report a 56-year-old man with symptomatic loculated malignant pleural effusion with an IPC, successfully drained with a single dose of 1 mg recombinant tissue plasminogen activator alteplase. This is the lowest dose currently applied in our centre for efficient drainage and improvement of dyspnoea.

Pathophysiology and causes of haemoptysis

2016 ◽  
Author(s):  
Francesco Blasi ◽  
Paolo Tarsia
Keyword(s):  
Pleural Effusion ◽  
Symptomatic Relief ◽  
Underlying Disease ◽  
Pleural Space ◽  
Bacterial Invasion ◽  
Pleural Effusions ◽  
Management Options ◽  
Indwelling Pleural Catheter ◽  
Malignant Effusions ◽  
Pleural Catheter

The main goal of management of pleural effusion is to provide symptomatic relief removing fluid from pleural space and the options depend on type, stage and underlying disease. The first diagnostic instrument is the chest radiography while ultrasound can be very useful to guide thoracentesis. Pleural effusion can be a transudate or an exudate. Generally a transudate is uncomplicated effusion treated by medical therapy, while an exudative effusion is considered complicated effusion and should be managed by drainage. Refractory non-malignant effusions can be transudative (congestive heart failure, cirrhosis, nephrosis) or exudative (pancreatitis, connective tissue disease, endocrine dysfunction), and the management options include repeated therapeutic thoracentesis, indwelling pleural catheter for intermittent external drainage, pleuroperitoneal shunts for internal drainage, or surgical pleurectomy. Parapneumonic pleural effusions can be divided in complicated when there is persistent bacterial invasion of the pleural space, uncomplicated and empyema with specific indications for pleural fluid drainage. Malignancy is the most common cause of exudative pleural effusions in patients aged >60 years and the decision to treat depends upon the presence of symptoms and the underlying tumour type. Options include indwelling pleural catheter drainage, pleurodesis, pleurectomy and pleuroperitoneal shunt. Hemothorax needs to be differentiated from a haemorrhagic pleural effusion and when is suspected the essential management is the intercostal drainage. It achieves two objectives to drain the pleural space allowing expansion of the lung and to allow assessment of rates of blood loss to evaluate the need for emergency or urgent thoracotomy.

scholarly journals A Novel Drug-Eluting Indwelling Pleural Catheter for the Management of Malignant Effusions

2018 ◽  
Vol 197 (1) ◽  
pp. 136-138 ◽  
Author(s):  
Rahul Bhatnagar ◽  
Natalie Zahan-Evans ◽  
Christine Kearney ◽  
Anthony J. Edey ◽  
Louise J. Stadon ◽  
...  
Keyword(s):  
Indwelling Pleural Catheter ◽  
Drug Eluting ◽  
Malignant Effusions ◽  
Pleural Catheter ◽  
Novel Drug

scholarly journals Pulling out a broken catheter using interventional radiology in a preterm. Neonatal intensive care

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Ismael José Dorta Luis ◽  
Paloma González Carretero ◽  
Carmen Luz Marrero Pérez ◽  
Ignacio Hernández Cabezudo ◽  
Antonio López Figueroa ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Recovery Time ◽  
Neonatal Intensive Care ◽  
Thoracoscopic Surgery ◽  
Preterm Newborn ◽  
Pleural Drainage ◽  
Bilateral Pneumothorax ◽  
Indwelling Pleural Catheter ◽  
First Case ◽  
Pleural Catheter

There are different indications for the placement of a pleural drainage. It is indicated in a massive pneumothorax or a pleural effusion, and a tunnelled indwelling pleural catheter is put in place. As in any procedure, complications may occur. A broken catheter is a rare one, and when it occurs, it has to be removed by thoracoscopic surgery. This article describes the first case of a removal of a fractured pleural catheter in a preterm newborn with a bilateral pneumothorax using interventional radiology. We propose an alternative way less invasive that could enable a shorter recovery time with fewer complications.

Nonintubated Uniportal Thoracoscopic Thymectomy with Laryngeal Mask

2019 ◽  
Vol 68 (05) ◽  
pp. 450-456 ◽  
Author(s):  
Zhengcheng Liu ◽  
Rusong Yang ◽  
Yang Sun
Keyword(s):  
Thoracoscopic Surgery ◽  
Anterior Mediastinum ◽  
Laryngeal Mask ◽  
Double Lumen Tube ◽  
Perioperative Outcomes ◽  
Video Assisted ◽  
Incision Size ◽  
The Mean ◽  
End Tidal ◽  
Video Assisted Thoracoscopic Surgery

Abstract Objective To investigate whether laryngeal mask anesthesia had more favorable postoperative outcomes than double-lumen tube intubation anesthesia in uniportal thoracoscopic thymectomy. Methods Data were collected retrospectively from December 2013 to December 2017. A total of 96 patients with anterior mediastinum mass underwent nonintubated uniportal video-assisted thoracoscopic thymectomy with laryngeal mask, and 129 patients underwent intubated uniportal video-assisted thoracoscopic thymectomy. A single incision of ∼3 cm was made in an intercostal space along the anterior axillary line. Perioperative outcomes between nonintubated uniportal video-assisted thoracoscopic surgery (NU-VATS) and intubated uniportal video-assisted thoracoscopic surgery (IU-VATS) were compared. Results In both groups, incision size was kept to a minimum, with a median of 3 cm, and complete thymectomy was performed in all patients. Mean operative time was 61 minutes. The mean lowest SpO2 during operation was not significantly different. However, the mean peak end-tidal carbon dioxide in the NU-VATS group was higher than in the IU-VATS group. Mean chest tube duration in NU-VATS group was 1.9 days. Mean postoperative hospital stay was 2.5 days, with a range of 1 to 4 days. Time to oral fluid intake in the NU-VATS group was significantly less than in the IU-VATS group (p < 0.01). Several complications were significantly less in the NU-VATS group than in the IU-VATS group, including sore throat, nausea, irritable cough, and urinary retention. Conclusion Compared with intubated approach, nonintubated uniportal thoracoscopic thymectomy with laryngeal mask is feasible for anterior mediastinum lesion, and patients recovered faster with less complications.

scholarly journals A New Multiplatform Model for Outpatient Prenatal and Postpartum Care in a Cohort of COVID-19-Affected Obstetric Patients

2021 ◽  
Vol 18 (10) ◽  
pp. 5144
Author(s):  
Mar Muñoz-Chápuli Gutiérrez ◽  
Ana Durán-Vila ◽  
Javier Ruiz-Labarta ◽  
Pilar Payá-Martínez ◽  
Pilar Pintado Recarte ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Specific Treatment ◽  
Rt Pcr ◽  
Good Adherence ◽  
Major Morbidity ◽  
Reference Hospital ◽  
The Mean ◽  
Discharge From Hospital ◽  
Over Time

Spain was one of the epicenters of the first wave of the COVID-19 pandemic. We describe in this article the design and results of a new telephone-and-telematic multiplatform model of systematic prenatal and postpartum follow-up for COVID-19-affected women implemented in a tertiary reference hospital in Madrid. We included patients with RT-PCR-confirmed COVID-19 during pregnancy or delivery from 10 March 2020 to 15 December 2020. We had a total of 211 obstetric patients: 148 (70.1%) were tested at the onset of suspicious clinical manifestations and 62 (29.4%) were tested in the context of routine screening. Of all the patients, 60 women (28.4%) were asymptomatic and 97 (46%) presented mild symptoms. Fifty-one women (24.2%) were admitted to our hospital for specific treatment because of moderate or severe symptoms. We had no missed cases and a good adherence. The mean number of calls per patient was 2.3. We performed 55 in-person visits. We analyzed the complexity of our program over time, showing a two-wave-like pattern. One patient was identified as needing hospitalization and we did not record major morbidity. Telemedicine programs are a strong and reproducible tool to reach to pregnant population affected by COVID-19, to assess its symptoms and severity, and to record for pregnancy-related symptoms both in an outpatient regime and after discharge from hospital.

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