{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:43:17Z","timestamp":1790739797856,"version":"4.1.0"},"reference-count":18,"publisher":"European Respiratory Society (ERS)","issue":"6","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Fondo de Investigaci\u00f3n en Salud (FIS), Instituto de Investigaci\u00f3n Carlos III","award":["PI9\/01401 and PI19\/01841"],"award-info":[{"award-number":["PI9\/01401 and PI19\/01841"]}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2026,1,10]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intrapleural enzyme therapy (IET) is widely used for pleural infections, including complicated parapneumonic effusions and empyema; however, the role of saline lavage alone or in combination with IET remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The SCOPE trial was a two-centre, prospective, randomised superiority study designed to determine whether saline lavage alone or combined with IET was superior to IET alone in adults with pleural infection. Patients were randomised in a 1:1:1 ratio to saline lavage alone, saline lavage plus IET (urokinase and DNase) or IET alone. Patients and outcome assessors were blinded to the treatment allocation. The primary end-point was the duration of pleural drainage. Secondary end-points included radiographic resolution, need for additional interventions, length of hospital stay, mortality and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>89 patients were analysed in three groups (saline lavage, n=30; saline+IET, n=30; IET, n=29). Baseline characteristics were broadly similar across the groups. The median (interquartile range) drainage duration was longer with saline lavage alone (4.0 (3.0\u20136.75)\u2005days) than with IET alone (3.0 (2.0\u20134.0)\u2005days; p=0.01) or saline lavage plus IET (3.0 (3.0\u20133.75)\u2005days; p=0.01). No significant difference was observed between the two IET-containing regimens (p=0.24). Secondary outcomes showed no clear advantage for saline lavage alone or in combination with IET.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In pleural infection, saline lavage alone results in a longer drainage duration than IET. In this small superiority trial, adding saline lavage to IET did not demonstrate a clinically meaningful advantage over IET alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/13993003.01715-2025","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T16:35:25Z","timestamp":1771518925000},"page":"2501715","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Saline lavage alone prolongs drainage compared with intrapleural enzyme therapy in pleural infection: the SCOPE randomised controlled trial"],"prefix":"10.1183","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2734-8061","authenticated-orcid":false,"given":"Jos\u00e9 M.","family":"Porcel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9023-0429","authenticated-orcid":false,"given":"Lucia","family":"Ferreiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Acosta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Civit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Su\u00e1rez-Antelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Rumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Vald\u00e9s","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Bielsa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"2026060401351594000_67.6.2501715.1","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00662-2023"},{"key":"2026060401351594000_67.6.2501715.2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00000211"},{"key":"2026060401351594000_67.6.2501715.3","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00593-2024"},{"key":"2026060401351594000_67.6.2501715.4","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01062-2022"},{"key":"2026060401351594000_67.6.2501715.5","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00147214"},{"key":"2026060401351594000_67.6.2501715.6","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s00408-016-9964-2","article-title":"Manual intrapleural saline flushing plus urokinase: a potentially useful therapy for complicated parapneumonic effusions and empyemas","volume":"195","author":"Porcel","year":"2017","journal-title":"Lung"},{"key":"2026060401351594000_67.6.2501715.7","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1055\/s-0042-1748186","article-title":"Nonmalignant pleural effusions","volume":"43","author":"Porcel","year":"2022","journal-title":"Semin Respir Crit Care Med"},{"key":"2026060401351594000_67.6.2501715.8","doi-asserted-by":"crossref","first-page":"20190027","DOI":"10.1515\/pp-2019-0027","article-title":"Two vs. three weeks of treatment with amoxicillin-clavulanate for stabilized community-acquired complicated parapneumonic effusions. A preliminary non-inferiority, double-blind, randomized, controlled trial","volume":"5","author":"Porcel","year":"2020","journal-title":"Pleura Peritoneum"},{"key":"2026060401351594000_67.6.2501715.9","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-1558"},{"key":"2026060401351594000_67.6.2501715.10","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02425-2020"},{"key":"2026060401351594000_67.6.2501715.11","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.ccm.2025.02.003","article-title":"Management of parapneumonic effusion and empyema","volume":"46","author":"Bhatnagar","year":"2025","journal-title":"Clin Chest Med"},{"key":"2026060401351594000_67.6.2501715.12","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1111\/crj.13415","article-title":"Saline lavage for the management of severe pleural empyema: a cohort study","volume":"15","author":"Guinde","year":"2021","journal-title":"Clin Respir J"},{"key":"2026060401351594000_67.6.2501715.13","doi-asserted-by":"crossref","first-page":"7700","DOI":"10.21037\/jtd-2025-923","article-title":"U-shaped threshold-balanced extensive pleural lavage system for empyema: a retrospective case-control study on drainage efficiency and clinical outcomes","volume":"17","author":"Liu","year":"2025","journal-title":"J Thorac Dis"},{"key":"2026060401351594000_67.6.2501715.14","doi-asserted-by":"crossref","first-page":"101354","DOI":"10.1016\/j.resinv.2025.101354","article-title":"Effect of large-volume intrapleural saline lavage for empyema: a single-center, prospective cohort study","volume":"64","author":"Kawataki","year":"2026","journal-title":"Respir Investig"},{"key":"2026060401351594000_67.6.2501715.15","doi-asserted-by":"publisher","DOI":"10.1136\/thorax-2023-220304"},{"key":"2026060401351594000_67.6.2501715.16","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1007\/s00408-015-9807-6","article-title":"Intrapleural fibrinolysis with urokinase versus alteplase in complicated parapneumonic pleural effusions and empyemas: a prospective randomized study","volume":"193","author":"Alem\u00e1n","year":"2015","journal-title":"Lung"},{"key":"2026060401351594000_67.6.2501715.17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1012740"},{"key":"2026060401351594000_67.6.2501715.18","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/j.chest.2025.11.042","article-title":"Use of and outcomes related to intrapleural enzyme therapy for complicated parapneumonic effusion and empyema in an integrated health system","volume":"169","author":"Solbes","year":"2026","journal-title":"Chest"}],"container-title":["European Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/13993003.01715-2025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T08:35:35Z","timestamp":1780562135000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/13993003.01715-2025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":18,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,4]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1183\/13993003.01715-2025"],"URL":"https:\/\/doi.org\/10.1183\/13993003.01715-2025","relation":{},"ISSN":["0903-1936","1399-3003"],"issn-type":[{"value":"0903-1936","type":"print"},{"value":"1399-3003","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,19]]}}}