case conference PGY1 timing of TPA dornase

BTS: 2010 guide, prior to MIST 2

BTS 2020 draft:

  • MIST2
    • 210, multicenter, double blinded, placebo controlled
    • 210 2005-2008
  • Piccolo
    • 107 patients, 8 respiratory centers in Australia, NZ, and UK. Retrospective observational study
    • tpa dornase instilled twice daily up to 6 days
    • tpa followed by flush followed by 40-60 min unclamping, free drainage for 40-60 min
    • followed by dnase, up to 6 doses
  • concurrent
    • retrospective cohort study 2010-2015, single institution, no study arm
    • 73 patients enrolled
    • concurrent tPA and DNase administration intrapleurally followed by 60cc saline flush
    • tube clamped for 2 hours before opened to -20 suction
    • therapy given twice daily for maximum of 6 doses
    • Overall success rate of 90.4%
  • management
    • 2012-2014,
    • once daily for 3 days
    • tpa instilled followed by 10-25cc flush. Tube clamped for 60 min then suctioned at -20 for 60 min. Followed by DNase