Using Ultrasound to Predict the Results of Draining Pleural Effusions
Pleural effusion is an extremely common problem with multiple causes; its subsequent investigation with thoracocentesis and treatment with drainage represent two of the most frequently performed diagnostic and therapeutic medical procedures. The role of thoracic ultrasonography in the management of pleural effusion is a modern and rapidly expanding one, having become effectively mandatory and part of the "gold standard" over the past decade due to its diagnostic and patient safety benefits. By contrast, the measurement of intra-pleural pressure using sequential manometry has failed to convincingly demonstrate its clinical value beyond physiological studies despite its availability for over a century. Previous work has shown a potential role for pleural manometry in predicting the presence of un-expandable lung and success of talc pleurodesis but these studies have not been replicated or clinically validated.
We intend to combine the old and new in an observational study comparing findings on thoracic ultrasonography and pleural manometry during thoracocentesis with patient-reported symptoms and the key clinical outcomes of presence of un-expandable lung and success of talc pleurodesis. We hypothesise that the previously described variations in pleural elastance can be correlated with appearances and anatomical changes visualised on thoracic ultrasonography; and in combination can be reliably utilised to predict clinical outcome. The study may allow the proposal of a treatment algorithm that allows patients with pleural effusion to be managed in a more expeditious and efficient manner.
Other: Pleural Manometry
Other: Thoracic ultrasonography
Procedure: Pleural aspiration catheter OR chest drain (standard care)
Procedure: Talc slurry pleurodesis via chest drain (standard care)
|Study Type:||Observational [Patient Registry]|
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Target Follow-Up Duration:||3 Months|
|Official Title:||Correlation of Pleural Manometry With Real-time Thoracic Ultrasound, Symptomatic Benefit and Clinical Outcome in Patients With Pleural Effusion: a Pilot Study|
- Diagnosis of unexpandable lung [ Time Frame: Up to 3 months ] [ Designated as safety issue: No ]Clinical and/or radiological diagnosis of unexpandable lung
- Failure of talc pleurodesis [ Time Frame: 3 months ] [ Designated as safety issue: No ]Failure of talc pleurodesis (defined as the need for a further repeat pleural procedure for symptom relief within 3 months of attempted pleurodesis).
- Absolute change in patient-reported symptoms [ Time Frame: Up to 3 months ] [ Designated as safety issue: No ]Absolute change in patient-reported symptoms (dyspnoea and chest discomfort) during pleural aspiration or drainage as measured using a visual analogue scale.
|Study Start Date:||November 2013|
|Estimated Study Completion Date:||August 2014|
|Estimated Primary Completion Date:||May 2014 (Final data collection date for primary outcome measure)|
Other: Pleural Manometry
Thoracic ultrasound scan will be done before drainage of pleural effusion - all participants.
Thoracic ultrasound scans will also be done during drainage of pleural effusion and the results will be recorded after every 100mL of pleural fluid drained - all participants.
Thoracic ultrasound scan will be done after drainage of pleural effusion - all participants.
Thoracic ultrasound scan will also be be done during clinic follow-up as part of routine clinical care - all participants.
Study-specific interventions will be the monitoring of intrapleural pressure using an electronic pleural manometer (Mirador Biomedical CompassTM Thoracentesis Assist Device) and thoracic ultrasonography. Both of these are considered non-invasive and low-risk to the study participants.
As part of their standard usual clinical care, participants will undergo a diagnostic and/or therapeutic pleural intervention in the form of thoracocentesis or pleural aspiration; intercostal chest drain insertion; and/or talc pleurodesis. All of these procedures are invasive and associated with potential complications that participants will be informed about as part of standard informed consent procedures. These interventions will however be clinically indicated and carried out whether or not an individual chooses to participate in this study. For those individuals who do participate in the study, any complications of these standard clinical care procedures will be recorded as part of the data collection process for the study.
|Contact: John Corcoran, MDfirstname.lastname@example.org|
|Contact: Magda Laskawiec-Szkonter, MAemail@example.com|
|Churchill Hospital||Not yet recruiting|
|Oxford, United Kingdom, OX3 7LE|
|Principal Investigator: John Corcoran, MD|
|Study Chair:||Najib Rahman, DPhil, MSc, MRCP||University of Oxford & Oxford University Hospitals NHS Trust|
|Principal Investigator:||John Corcoran, MD||University of Oxford|