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Point/Counterpoint Editorials |

Point: Should Fibrinolytics Be Routinely Administered Intrapleurally for Management of a Complicated Parapneumonic Effusion? YesFibrinolytics for Effusion? Yes

John P. Corcoran, MD; Najib M. Rahman, DPhil
Author and Funding Information

From the Oxford Centre for Respiratory Medicine (Drs Corcoran and Rahman), Oxford University Hospitals; Oxford Respiratory Trials Unit (Drs Corcoran and Rahman), University of Oxford; and NIHR Oxford Biomedical Research Centre (Dr Rahman).

Correspondence to: Najib M. Rahman, DPhil, Oxford Respiratory Trials Unit, Oxford University Hospitals, Old Rd, Oxford, OX3 7LE, England; e-mail: najib.rahman@ndm.ox.ac.uk


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Rahman was the corresponding author for the Multicenter Intrapleural Sepsis Trial 2 (MIST2) study and is the current clinical director of the Oxford Respiratory Trials Unit, which received an unrestricted educational grant from Roche UK to the University of Oxford for the conduct of the MIST2 study. Dr Corcoran has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(1):14-17. doi:10.1378/chest.13-2354
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Extract

The introduction of a therapeutic intervention into everyday clinical practice must always be given careful consideration by physicians regarding the risks and benefits the intervention poses to patients. Factors to be taken into account are the incidence of the condition being targeted, the morbidity and mortality associated with the condition, the adequacy of preexisting therapeutic approaches, the side-effect profile of the proposed intervention, and the additional financial cost incurred during the care of the patient. In this regard, one can make a strong and valid argument for the routine administration of intrapleural fibrinolytics for pleural infection (complicated parapneumonic effusion or empyema thoracis) in adults.

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