Early Video-Assisted Thoracoscopic Surgery or Intrapleural Enzyme Therapy in Pleural Infection: A feasibility randomized controlled trial. The Third Multicentre Intrapleural Sepsis Trial -- MIST-3

Bedawi EO, Stavroulias D, Hedley E, Blyth KG, Kirk A, De Fonseka D, Edwards JG, Internullo E, Corcoran JP, Marchbank A, Panchal R, Caruana E, Kadwani O, Okiror L, Saba T, Purohit M, Mercer RM, Taberham R, Kanellakis N, Condliffe AM, Lewis LG, Addala DN, Asciak R, Banka R, George V, Hassan M, McCracken D, Sundaralingam A, Wrightson JM, Dobson M, West A, Barnes G, Harvey J, Slade M, Chester-Jones M, Dutton S, Miller RF, Maskell NA, Belcher E, Rahman NM

Am J Respir Crit Care Med. 2023 Dec 15;208(12):1305-1315.

What is the key question?

  • Testing the feasibility of a randomized controlled trial (RCT) to compare early video-assisted thoracoscopic surgery (VATS) to early intrapleural enzyme treatment (IET) in pleural infection

What is the bottom line?

  • Pre-defined feasibility criteria were met indicating suitability to conduct a larger RCT, and this despite Covid-19 affecting recruitment and the RCT having 3 arms (VATS, IET and standard care)
  • The IET cohort had more pain compared to VATS, but lower median hospital days (7 versus 9.5 days)
  • There were no significant differences in readmission rates or need for re-intervention between the groups

Why read on?

  • To gain insight into novel feasibility of comparing surgical and non-surgical management of pleural infection in a RCT
  • To obtain insight on how the different treatment options available can be complimentary due to various reasons
  • The authors also report on a number of other pleural infection-related secondary endpoints from the data collected