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Point/Counterpoint Editorials |

Rebuttal From Drs Corcoran and RahmanRebuttal From Drs Cocoran and Rahman

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):20-21. doi:10.1378/chest.13-2355
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Extract

In their counterpoint editorial, Drs Colice and Idell1 reject the routine administration of intrapleural fibrinolytics for complicated parapneumonic effusions (pleural infection) on two key grounds: (1) There is no evidence of clinical benefit or efficacy for usual dosing regimens of fibrinolytics in isolation and (2) an alternative approach with video-assisted thoracoscopic surgery (VATS) offers both effective drainage of the pleural space and improved clinical outcomes. We addressed this latter point and demonstrated there is no robust, randomized evidence that surgical intervention for pleural infection offers any advantage with respect to clinical outcomes. While acknowledging that VATS is more attractive as an interventional prospect than open thoracotomy,2 it remains a procedure with both immediate and long-term complications that should not be considered benign in a population where the majority of cases can already be successfully managed medically.3,4 Drs Colice and Idell1 do acknowledge the pediatric randomized studies that have shown a greater financial cost and no clinical advantage of VATS compared with medical management of pleural infection, but currently there are no robust data indicating that the situation in adult patients is any different.

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