| Title: |
Thoracic Irrigation Using CLR Irrigator for Complicated Pleural Infection |
| Authors: |
Uribe, J.; Parrish, R.C.; Pyarali, F.; Kheir, F. |
| Source: |
American Journal of Respiratory and Critical Care Medicine ; volume 211, issue Supplement_1, page A1139-A1139 ; ISSN 1073-449X 1535-4970 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2025 |
| Description: |
Rationale: Pleural infections are a significant cause of morbidity and mortality, particularly in elderly patients and those with comorbidities who are often unsuitable for surgery. Treatment typically involves antibiotics and drainage, but in approximately 30% of cases, loculations and increased fluid viscosity hinder effective drainage. Intrapleural enzymatic therapy (IET) with tissue plasminogen activator (tPA) and DNase improves drainage but carries a bleeding risk, especially in patients with coagulopathies. This study investigates the use of the CLR Irrigator (Figure 1) as a safer alternative for patients with contraindications to IET. Methods: We retrospectively reviewed four patients with complicated pleural infections contraindicated for IET due to concurrent anticoagulation, recent hemorrhage, or coagulopathy. Each patient underwent ultrasound-guided placement of a 14 French chest tube. The CLR Irrigator was used to instill warm saline (100–500 mL) into the pleural space, followed by alternating cycles of irrigation and suction. Irrigation sessions were performed daily until clinical improvement. Chest CT scans were obtained pre- and post-irrigation to evaluate changes in pleural effusion. Results: Thoracic irrigation was well tolerated in all cases, with a median chest tube duration of 4 days (range: 1-9 days). Significant radiographic improvement in pleural opacity was observed across all patients (Figure 1). No major adverse events occurred, though one patient experienced saline leakage around the CLR port and another reported transient chest discomfort. None required further pleural intervention. Clinical improvement was achieved in all patients. Conclusion: The CLR Irrigator provides a safe and effective alternative to IET in managing complicated pleural infections, particularly in patients with bleeding risks or contraindications to surgery. This method allows precise control of irrigation and drainage, leading to rapid clinical and radiographic improvement. Further prospective studies ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1164/ajrccm.2025.211.abstracts.a1139 |
| Availability: |
https://doi.org/10.1164/ajrccm.2025.211.abstracts.a1139; https://academic.oup.com/ajrccm/article-pdf/211/Supplement_1/A1139/67026209/ajrccm_211_abstracts_a1139.pdf |
| Rights: |
https://academic.oup.com/pages/standard-publication-reuse-rights |
| Accession Number: |
edsbas.9DD3F3BE |
| Database: |
BASE |