The Fourth Multicentre Intrapleural Sepsis Trial (MIST-4) - randomised clinical effectiveness study comparing early video assisted thoracic surgery and early intrapleural enzyme therapy in adult patients with pleural infection

Research summary

We will invite 604 patients from multiple hospitals across the United Kingdom who are eligible to take part in this trial. Those who agree will be randomised (assigned by computer) to early VATS or early IET. We will compare how successful each of the treatments is by seeing how often patients need further treatment,which is the priority of patients with this disease. This study hypothesises that treatment failure (the key patient priority) is lower using initial VATS compared with initial IET in patients with pleural infection. The rationale is that early VATS debridement may achieve this by: 1) Providing definitive and effective drainage of infected fluid early in treatment 2) Avoid the treatment time required with IET (which requires 3 days of intrapleural treatment to be effective) 3) That these benefits will occur despite the clinical reality of awaiting surgical capacity or transfer to another hospital. Key unknowns which will be addressed in this study include post intervention chest pain,quality of life,delays in treatment,mortality and costs comparing the two treatments.

Principal Investigator

Mr Eihab Bedawi

Contact us

Email: samantha.chilcott@ndm.ox.ac.uk

IRAS number

1012038