Event

Despite advances in the field, controversies still surround the use of intrapleural fibrinolytic therapy (IPFT) versus surgery for the treatment of pleural loculation. Evidence supporting the use of nonsurgical options has emerged, while the dosing and form of IPFT that best expedites pleural drainage remains to be determined. The integrated use of appropriate antibiotic therapy and chest tube placement with IPFT can accomplish pleural drainage in most patients and clinical laboratory assessment can identify patients most likely to mitigate risks of bleeding. New dose de-escalation trials of tPA/DNase (ADAPT) and a dose escalation trial of single chain urokinase plasminogen activator (LTI-01)are enrolling and may inform better near term strategies to achieve safe and optimally effective pleural drainage.