Randomized Controlled Trial Comparing an Early Pleural Irrigation Strategy With Saline to the Standard of Care for the Management of Complicated Pleural Infections.

Inclusion Criteria: * Adults (≥18 years old) capable of fully understanding the study; * Complicated pleural infection (macroscopically purulent fluid, positive for bacteria on Gram's staining, positive on culture for bacterial infection, loculated effusion, pH \<7.2, great abundance) leading to thoracic drainage; * Initial ultrasound evaluation to estimate pleural fluid abundance and detect fibrinous septation; * Social security affiliation * Written informed consent * Highly effective contraceptive methods for women of childbearing age include: Combined hormonal contraception (estrogen and progestogen) associated with inhibition of ovulation (oral, intravaginal, transdermal); progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable); intrauterine device; hormone- releasing intrauterine system; bilateral occlusion of the Fallopian tubes; vasectomized partner; sexual abstinence Exclusion Criteria: * Tuberculous pleural effusions; * Previous treatment with intrapleural fibrinolytic agents (urokinase, streptokinase, alteplase, or DNase) or intrapleural saline lavage; * Previous thoracic surgery for pleural infection; * Contraindications to auxiliary treatments, to fibrinolysis or surgery as well as to procedures such as drainage and lavage; * Pregnancy or lactation; * Expected survival of less than 3 months; * Thoracic drainage since more than 24h; * Patient deprived of liberty by administrative or judicial decision or pl…