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Hooper CE, Edey AJ, Wallis A, Clive AO, Morley A, White P, Medford ARL, Harvey JE, Darby M, Zahan-Evans N, Maskell NA. Pleural irrigation trial (PIT): a randomised controlled trial of pleural irrigation with normal saline versus standard care in patients with pleural infection. Eur Respir J 2015; 46:456-463. [PMID: 26022948 DOI: 10.1183/09031936.00147214] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 03/12/2015] [Indexed: 02/07/2023]
Abstract
Pleural infection is increasing in incidence. Despite optimal medical management, up to 30% of patients will die or require surgery. Case reports suggest that irrigation of the pleural space with saline may be beneficial.A randomised controlled pilot study in which saline pleural irrigation (three times per day for 3 days) plus best-practice management was compared with best-practice management alone was performed in patients with pleural infection requiring chest-tube drainage. The primary outcome was percentage change in computed tomography pleural fluid volume from day 0 to day 3. Secondary outcomes included surgical referral rate, hospital stay and adverse events.35 patients were randomised. Patients receiving saline irrigation had a significantly greater reduction in pleural collection volume on computed tomography compared to those receiving standard care (median (interquartile range) 32.3% (19.6-43.7%) reduction versus 15.3% (-5.5-28%) reduction) (p<0.04). Significantly fewer patients in the irrigation group were referred for surgery (OR 7.1, 95% CI 1.23-41.0; p=0.03). There was no difference in length of hospital stay, fall in C-reactive protein, white cell count or procalcitonin or adverse events between the treatment groups, and no serious complications were documented.Saline irrigation improves pleural fluid drainage and reduces referrals for surgery in pleural infection. A large multicentre randomised controlled trial is now warranted to evaluate its effects further.
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Affiliation(s)
- Clare E Hooper
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK Pleural Clinical Trials Unit, North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - Anthony J Edey
- Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Anthony Wallis
- Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Amelia O Clive
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK Pleural Clinical Trials Unit, North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - Anna Morley
- Pleural Clinical Trials Unit, North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - Paul White
- Statistical Department, University of West of England, Bristol, UK
| | - Andrew R L Medford
- Pleural Clinical Trials Unit, North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - John E Harvey
- Pleural Clinical Trials Unit, North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - Mike Darby
- Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Natalie Zahan-Evans
- Pleural Clinical Trials Unit, North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - Nick A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK Pleural Clinical Trials Unit, North Bristol Lung Centre, Southmead Hospital, Bristol, UK
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Lee MT, Hsi SC, Hu P, Liu KY. Biliopleural fistula: A rare complication of percutaneous transhepatic gallbladder drainage. World J Gastroenterol 2007; 13:3268-70. [PMID: 17589912 PMCID: PMC4436619 DOI: 10.3748/wjg.v13.i23.3268] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage, but returned to the hospital two days after discharge with a rare complication of this technique, biliopleural fistula. A thoracostomy tube was inserted to drain the pleural effusion, and the patient’s previous antibiotics reinstated. After two weeks of drainage and antibiotics, the fistula healed spontaneously without the need for further intervention.
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Affiliation(s)
- Ming-Tsung Lee
- Division of General Surgery, Department of Surgery, Armed Forces Taoyuan General Hospital, No.168 Chung-Shin Rd, Taoyuan, Taiwan, China
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Abstract
The management of pleural sepsis involves early diagnosis, administration of appropriate antibiotics, recognition of poor prognostic features and timely intervention to drain the infected pleural space. Important recent advances in the management of pleural sepsis include better imaging techniques, the use of flexible image-guided drainage catheters, adjunctive intrapleural thrombolytic therapy and the introduction of interventional thoracoscopy. These advances have been augmented, in the past year, by results from prospective controlled studies comparing different therapeutic options. This review describes an evidence-based approach to the management of pleural sepsis which incorporates recent therapeutic advances.
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Affiliation(s)
- T K Lim
- Department of Medicine, National University Hospital, Singapore.
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