PulmPEEPs 97. Rapid Fire Journal Club – MIST 2
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Apr 8, 2025 Discover innovative treatment strategies for infected pleural effusions as the discussion dives into the MIST 2 trial. Learn how the combination of tPA and DNase is reshaping standard care, emphasizing their effectiveness in reducing fluid size and minimizing surgical interventions. The podcast highlights the critical importance of patient selection criteria and protocol adherence in clinical trials. With insights on the dynamics of interventions and patient management, this exploration is a must-listen for anyone interested in advancements in pulmonology.
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Synergistic Effect of tPA and DNase
- The MIST-2 trial found that combining intrapleural tPA and DNase improves drainage in infected pleural effusions and empyemas.
- Previous MIST-1 trial using streptokinase showed no benefit, highlighting the synergistic effect of this combination therapy.
Double-Blind Double-Dummy Method
- Use a double-blind, double-dummy, 2×2 factorial RCT design to eliminate bias when testing intrapleural therapies.
- Ensure placebo controls are included for both agents to maintain blinding in procedural drug administration studies.
Outcome Measures Focused on Drainage & Clinical Benefit
- Primary outcome measured was reduction in percentage of hemithorax occupied by effusion on day 7.
- Secondary outcomes included referral for surgery, hospital length of stay, mortality, and adverse events to assess clinical impact.