Concurrent versus sequential intrapleural administration of fibrinolytic and DNase for pleural infections: a...

Traditional sequential administration of fibrinolytics and deoxyribonuclease (DNase) for pleural infections is a multi-step process that can be time-consuming and resource-intensive in busy clinical settings. This meta-analysis evaluated whether concurrent intrapleural administration offers comparable effectiveness and safety to sequential dosing in adults with pleural infections.

A systematic search of PubMed, Scopus, and Web of Science identified studies comparing concurrent versus sequential intrapleural fibrinolytic and DNase therapy. The primary outcome was treatment success, defined as survival and avoidance of surgery. Secondary outcomes included hospital length of stay (LOS), total doses administered, chest tube duration, pleural drainage volume, and complications.

Three studies involving 357 patients (sequential: N=128; concurrent: N=229) were included. Baseline characteristics were similar across the groups. Pooled analysis showed no significant difference in treatment success (14.1% vs. 16.6%; relative risk (RR): 1.11; 95% confidence interval (CI): 0.63-1.96; P=0.72) between the two groups. Mortality (RR: 1.11; P=0.82), surgical intervention (RR: 1.15; P=0.76), hospital LOS [mean difference (MD): -1.20 days; P=0.30], and pleural drainage volume (MD: -0.09 L; P=0.38) were also comparable. The groups showed no significant differences in the number of doses administered (MD: 0.35; P=0.09) or chest tube duration (MD: -0.67 days; P=0.32). Complication rates for pain (RR: 0.81; P=0.46) and bleeding (RR: 1.42; P=0.67) did not differ significantly.

Current evidence suggests that concurrent intrapleural administration of fibrinolytics and DNase may have similar effectiveness and safety to sequential therapy. However, these findings should be interpreted cautiously given the limited and observational nature of the available evidence.