MIST-2
Intrapleural tPA + DNase in Pleural Infection
Patient / Population Intervention / Exposure Comparison Outcome
In 210 patients with pleural infection, intrapleural tPA + DNase twice daily for 3 days reduced pleural opacity and surgical referral compared with placebo or single-agent therapy.
N
210
Design
2×2 factorial RCT
Endpoint
Pleural opacity on CXR at day 7
Relevance
2
Result-29.5% (combo) vs -17.2% (placebo; p=0.005); surgical referral 4% vs 16% (p=0.03); shorter LOS. Monotherapy ineffective.
Rahman NM, et al. N Engl J Med. 2011;365(6):518-526. 10.1056/NEJMoa1012740
Discussion & critique
Established combination intrapleural tPA/DNase for pleural infection failing chest-tube drainage.