Introduction and Objectives In a large-scale, multicentered randomised trial, intrapleural administration of streptokinase has been proved unsuccessful among patients with pleural infection but >80% of them had visibly purulent pleural fluid while small bore chest tubes (median diameter: 12F) had been used. The aim of our study was to investigate lung function and exercise capacity after intrapleural administration of recombinant tissue plasminogen activator (t-PA) in adult patients with complicated parapneumonic pleural effusion (CPE).

Methods Fifteen consecutive patients (mean age 50.2±19.3 years) with CPE were included. Chest tube (13 patients: 32F, 2 patients: 10F) was inserted under guidance of computed tomography and all patients received IV antibiotics. After pleural fluid drainage has been stopped for 24 h, 25 mg t-PA/day was administered via chest tube for two consecutive days. We evaluated patients with spirometry before t-PA, 1 day after chest tube removal and 1 month after discharge. During the second and third time-point evaluations, 6 min walking test was also performed.

Results Patients reported symptoms 10.7±7.4 days before hospital admission while all of them demonstrated loculated effusions on computed tomography. The mean production of fluid was 721.3±821.7 ml before and 1.500±107.1 ml after t-PA administration (p<0.001). Improvement in lung function and exercise capacity during follow-up are presented on Abstract P36 table 1. FVC had been increased by 572.6±653.5 ml initially and by 575.8±366.6 ml 1 month later. VATS was necessary only for one patient. Adverse events were pain (7/15) and minor bleeding (2/15) at the site of chest tube insertion.

Conclusion Intrapleural administration of t-PA for CPE was an effective treatment considering functional status of the respiratory system during follow-up.