Short Duration High Intensity Intrapleural Alteplase With Pulmozyme in Pleural Infection Management

Inclusion Criteria: * adult patient with age more than 17 year old * evidence of complex parapneumonic effusion or empyema; with poor pleural fluid drainage of ≤150 mL after 24 hours of insertion of chest drain * clinical evidence of infection such as fever and or elevated C-reactive protein (CRP) or white-cell count * complex pleural effusion proven by ultrasound * pleural fluid analysis that fulfilled at least one of the characteristics: frank pus, exudative nature (according to light's criteria), gram stain or culture positive, lactate dehydrogenase (LDH) \> 1000 U/L, pH \< 7.2 and/or glucose level \< 3.3mmol/L Exclusion Criteria: * known allergy to pulmozyme or alteplase * acute stroke, active bleeding diathesis * major surgery in past 5 days * previous pneumonectomy on the infected side * bronchopleural fistula * pregnancy * coagulopathy (INR \> 2, APTT \>100, platelet count \< 50,000 cells)