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Clinical Response-Guided tPA and DNase Administration as Rescue Treatment for Postoperative Empyema

Empyema untreated carries significant mortality. Medical management with tube thoracostomy
accompanied by combination therapy with intrapleural tissue plasminogen activator (tPA) and
deoxyribonuclease (DNase, dornase alpha) has decreased the need for surgical intervention.
Most studies on this combination therapy have been done on empyema associated with community acquired pneumonia. A fixed regimen of tPA and DNase has a high cost and carries a small
risk of intrapleural hemorrhage. We report on two patients who developed empyema postoperatively. Intrapleural DNase and tPA were administered concurrently at a frequency and duration
based upon the clinical response. Both patients had successful outcomes without adverse effects.