Use of fibrinolytics and deoxyribonuclease in adult patients with pleural empyema: a consensus statement

被引:41
作者
Chaddha, Udit [1 ]
Agrawal, Abhinav [2 ]
Feller-Kopman, David [3 ]
Kaul, Viren [4 ]
Shojaee, Samira [5 ]
Maldonado, Fabien [6 ]
Ferguson, Mark K. [7 ]
Blyth, Kevin G. [8 ,9 ]
Grosu, Horiana B. [10 ]
Corcoran, John P. [11 ]
Sachdeva, Ashutosh [12 ]
West, Alex [13 ]
Bedawi, Eihab [14 ,15 ]
Majid, Adnan [16 ]
Mehta, Ravindra M. [18 ]
Folch, Erik [17 ]
Liberman, Moishe [19 ]
Wahidi, Momen M. [20 ]
Gangadharan, Sidhu P. [16 ]
Roberts, Mark E. [21 ]
DeCamp, Malcolm M. [22 ]
Rahman, Najib M. [15 ]
机构
[1] Icahn Sch Med Mt Sinai, Div Pulm Crit Care & Sleep Med, New York, NY 10029 USA
[2] Donald & Barbara Zucker Sch Med Hofstra Northwell, Div Pulmonary Crit Care & Sleep Med, New Hyde Pk, NY USA
[3] Johns Hopkins Univ, Dept Otolaryngol Head & Neck Surg, Baltimore, MD USA
[4] SUNY Upstate Med Univ, Dept Pulm & Crit Care Med, Crouse Hlth, Syracuse, NY 13210 USA
[5] Virginia Commonwealth Univ, Div Pulm & Crit Care Med, Dept Med, Richmond, VA USA
[6] Vanderbilt Univ, Med Ctr, Div Allergy Pulm & Crit Care Med, Nashville, TN USA
[7] Univ Chicago, Med Ctr, Sect Thorac Surg, Chicago, IL 60637 USA
[8] Univ Glasgow, Inst Canc Sci, Glasgow, Lanark, Scotland
[9] Univ Glasgow, Glasgow Pleural Dis Unit, Glasgow, Lanark, Scotland
[10] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA
[11] Univ Hosp Plymouth NHS Trust, Intervent Pulmonol Serv, Plymouth, Devon, England
[12] Univ Maryland, Div Pulm & Crit Care Med, Baltimore, MD 21201 USA
[13] Guys & St Thomas NHS Fdn Trust, London, England
[14] Oxford Univ Hosp NHS Trust, Oxford Ctr Resp Med, Oxford, England
[15] Univ Oxford, Oxford Resp Trials Unit, Oxford, England
[16] Harvard Med Sch, Massachusetts Gen Hosp, Beth Israel Deaconess Med Ctr, Dept Surg,Div Thorac Surg & Intervent Pulmonol, Boston, MA 02115 USA
[17] Harvard Med Sch, Massachusetts Gen Hosp, Beth Israel Deaconess Med Ctr, Complex Chest Dis Ctr, Boston, MA 02115 USA
[18] Apollo Hosp, Dept Pulm & Crit Care, Bangalore, Karnataka, India
[19] Univ Montreal, Div Thorac Surg, Montreal, PQ, Canada
[20] Duke Univ, Med Ctr, Dept Med, Div Pulm Allergy & Crit Care, Durham, NC 27710 USA
[21] Sherwood Forest Hosp NHS Fdn Trust, Sutton In Ashfield, England
[22] Univ Wisconsin, Div Cardiothorac Surg, Madison, WI USA
关键词
TISSUE-PLASMINOGEN ACTIVATOR; COMPLICATED PARAPNEUMONIC EFFUSIONS; ASSISTED THORACOSCOPIC SURGERY; RANDOMIZED CONTROLLED-TRIAL; INTRAPLEURAL STREPTOKINASE; THORACIC-SURGERY; SURGICAL-TREATMENT; NORMAL SALINE; MANAGEMENT; DECORTICATION;
D O I
10.1016/S2213-2600(20)30533-6
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Although our understanding of the pathogenesis of empyema has grown tremendously over the past few decades, questions still remain on how to optimally manage this condition. It has been almost a decade since the publication of the MIST2 trial, but there is still an extensive debate on the appropriate use of intrapleural fibrinolytic and deoxyribonuclease therapy in patients with empyema. Given the scarcity of overall guidance on this subject, we convened an international group of 22 experts from 20 institutions across five countries with experience and expertise in managing adult patients with empyema. We did a literature and internet search for reports addressing 11 clinically relevant questions pertaining to the use of intrapleural fibrinolytic and deoxyribonuclease therapy in adult patients with bacterial empyema. This Position Paper, consisting of seven graded and four ungraded recommendations, was formulated by a systematic and rigorous process involving the evaluation of published evidence, augmented with provider experience when necessary. Panel members participated in the development of the final recommendations using the modified Delphi technique. Our Position Paper aims to address the existing gap in knowledge and to provide consensus-based recommendations to offer guidance in clinical decision making when considering the use of intrapleural therapy in adult patients with bacterial empyema.
引用
收藏
页码:1050 / 1064
页数:15
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