RecentRCT

SCOPE

Saline lavage alone prolongs drainage compared with intrapleural enzyme therapy in pleural infection: the SCOPE randomised controlled trial

European Respiratory Journal, 2026 · Two-center randomized superiority trial, 89 analyzed patients

Population: Adults with pleural infection
Intervention: Saline lavage alone or saline lavage plus intrapleural urokinase and DNase
Comparator: Intrapleural urokinase and DNase alone
Primary outcome: Duration of pleural drainage
Result: Median drainage was four days with lavage alone versus three with enzyme therapy. Adding lavage to enzyme therapy did not demonstrate a clear advantage.

What the trial found

Median drainage was four days with lavage alone versus three with enzyme therapy. Adding lavage to enzyme therapy did not demonstrate a clear advantage.

Current guideline position

This trial must be interpreted alongside indication-specific guidance; its result alone does not establish a universal treatment policy.

Clinical interpretation

Saline lavage should not be assumed equivalent to intrapleural enzyme therapy; this small study does not establish mortality effects or compare every enzyme regimen.

Limitations

Small two-center trial.
Urokinase and DNase differs from tPA/DNase protocols.

Clinical Context & Relevant Topics (2)

Disease Reference

Pleural Infection / Empyema

Diagnosis and source control of complicated parapneumonic effusion and empyema with drainage, tPA/DNase and surgical escalation

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Chest Tube & Pleural Drain Management

Ultrasound-guided pleural drain selection, insertion safety, troubleshooting and complication management in critically ill adults.

View Topic Context →