{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:17:48Z","timestamp":1792412268724,"version":"4.4.0"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T00:00:00Z","timestamp":1702857600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pulmonary Medicine"],"published-print":{"date-parts":[[2023,12,18]]},"abstract":"<jats:p>Background and Objective. Intrapleural tissue plasminogen activator\/deoxyribonuclease (tPA\/DNase) is increasingly being used for pleural infections. Compared to sequential instillation of tPA\/DNase, concurrent instillation considerably reduces the complexity of the administration process and reduces workload and the number of times the chest drain is accessed. However, it remains unclear if concurrent intrapleural therapy is as efficacious or safe as sequential intrapleural therapy. Methods. We conducted a retrospective review of patients with pleural infection requiring intrapleural therapy at two tertiary referral centres. Results. We included 84 (62.2%) and 51 (37.8%) patients who received sequential and concurrent intrapleural therapy, respectively. Patient demographics and clinical characteristics, including age, RAPID score, and percentage of pleural opacity on radiographs before intrapleural therapy, were similar in both groups. Treatment failure rates (defined by either in-hospital mortality, surgical intervention, or 30-day readmission for pleural infection) were 9.5% and 5.9% with sequential and concurrent intrapleural therapy, respectively (<jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>p<\/a:mi>\n                        <a:mo>=<\/a:mo>\n                        <a:mn>0.534<\/a:mn>\n                     <\/a:math>\n                  <\/jats:inline-formula>). This translates to a treatment success rate of 90.5% and 94.1% for sequential and concurrent intrapleural therapy, respectively. There was no significant difference in the decrease in percentage of pleural effusion size on chest radiographs (15.1% [IQR 6-35.7] versus 26.6% [IQR 9.9-38.7], <jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>p<\/c:mi>\n                        <c:mo>=<\/c:mo>\n                        <c:mn>0.143<\/c:mn>\n                     <\/c:math>\n                  <\/jats:inline-formula>) between sequential and concurrent therapy, respectively. There were also no significant differences in the rate of pleural bleeding (4.8% versus 9.8%, <jats:inline-formula>\n                     <e:math xmlns:e=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\">\n                        <e:mi>p<\/e:mi>\n                        <e:mo>=<\/e:mo>\n                        <e:mn>0.298<\/e:mn>\n                     <\/e:math>\n                  <\/jats:inline-formula>) and chest pain (13.1% versus 9.8%, <jats:inline-formula>\n                     <g:math xmlns:g=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\">\n                        <g:mi>p<\/g:mi>\n                        <g:mo>=<\/g:mo>\n                        <g:mn>0.566<\/g:mn>\n                     <\/g:math>\n                  <\/jats:inline-formula>) between sequential and concurrent therapy, respectively. Conclusion. Our study adds to the growing literature on the safety and efficacy of concurrent intrapleural therapy in pleural infection.<\/jats:p>","DOI":"10.1155\/2023\/6340851","type":"journal-article","created":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T19:05:08Z","timestamp":1702926308000},"page":"1-7","source":"Crossref","is-referenced-by-count":10,"title":["A Retrospective Cohort Study Evaluating the Safety and Efficacy of Sequential versus Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection"],"prefix":"10.1155","volume":"2023","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5243-5167","authenticated-orcid":true,"given":"Ken Junyang","family":"Goh","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wui Mei","family":"Chew","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine Chiat Ling","family":"Ong","sequence":"additional","affiliation":[{"name":"Division of Pharmacy, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie Kah-Lai","family":"Leong","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran Bin","family":"Mohamed Noor","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devanand","family":"Anantham","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li Yan Sandra","family":"Hui","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindy Chu Ming","family":"Choong","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlene Jin Yee","family":"Liew","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Changi General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marnie Tamayo","family":"Gutierrez","sequence":"additional","affiliation":[{"name":"Advanced Practice Nurse Development, Changi General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane Jing Yi","family":"Wong","sequence":"additional","affiliation":[{"name":"Division of Nursing, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana Gilcrist Chiew Sian","family":"Phua","sequence":"additional","affiliation":[{"name":"Division of Nursing, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen Ting","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Nursing, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiao Li","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2020-215267"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00130-2020"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2010.156406"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042473"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1012740"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.2072-1439.2015.01.30"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002312.pub4"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1177\/02184923231180990"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(20)30533-6"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201602-127OC"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1097\/LBR.0000000000000334"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.2214"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-020-05210-2"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.1097\/LBR.0000000000000461"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00590-2021"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-1558"},{"key":"17","article-title":"Doctor 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