Lavado salino solo prolonga el drenaje en comparación con la terapia enzimática intrapleural en la infección pleural:...

Intrapleural enzyme therapy (IET) is widely used for pleural infections, including complicated parapneumonic effusions (CPPE) and empyema; however, the role of saline lavage alone or in combination with IET remains uncertain.

The SCOPE trial was a two-center, 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 endpoint was the duration of pleural drainage. Secondary endpoints included radiographic resolution, need for additional interventions, length of hospital stay, mortality, and adverse events.

Eighty-nine patients were analysed (saline, n=30; saline+IET, n=30; IET, n=29). Baseline characteristics were broadly similar across the groups. The median drainage duration was longer with saline lavage alone (4.0 days [IQR 3.0-6.75]) than with IET alone (3.0 days [2.0-4.0], p=0.01) or saline+IET (3.0 days [3.0-3.75], 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.

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.