Chest Tube Placement Research Articles

Bilateral Spontaneous Hemothorax: A Rare Case of Primary Pleural Angiosarcoma and Literature Review

Introduction and case report: Angiosarcomas, rare soft tissue malignancies originating from endothelial cells, represent only 1–2% of all soft tissue sarcomas. Primary pleural angiosarcoma (PPA) is exceptionally rare, with only 43 reported cases since 1943. There are many diagnostic and therapeutic challenges due to the rarity of these tumors. We present the case of a 72-year-old man presenting with back pain, dyspnea and anemia. Conventional imaging revealed bilateral pleural effusion and a thickened parietal pleura, while contrast chest MR was able to identify pleural sites of contrast enhancement. Left chest tube placement evidenced a hemothorax, and the cytology result was negative. A thoracoscopic approach was chosen, allowing us to perform different parietal pleural biopsies. Radiological and pathological features led to the diagnosis of epithelioid PPA. Despite pleural drainage and blood transfusions, the patient died only 4 days after diagnosis. Objectives: To present a literature review, evaluating the disease epidemiology and the clinical, diagnostic and therapeutic features of PPA. Methods: We reviewed cases of PPA in the literature (1954–2024) by searching the PubMed database for the terms “pleural angiosarcoma” and “pleura + angiosarcoma”. Results: We found a total of 47 cases that were described between 1987 and 2024 with sufficient data to be included in our review. PPA was found to be a challenging diagnosis, found mostly in older Caucasian males. The cytology is mostly indeterminant, and an endoscopic approach is usually needed. Radical surgery is the most common treatment option, and chemotherapy and radiation therapy are also often used. However, the prognosis is poor. Conclusions: PPA is very rare, and complex cases such as this one showcase the importance of innovative approaches like MRI and emphasize the significance of multidisciplinary collaboration for optimal patient management. Bilateral spontaneous hemothorax, as seen in this case, is uncommon and poses additional challenges in disease management. Further research to advance the diagnostic capabilities and treatment efficacy is needed.

Comparison of different adjuvant analgesia for paravertebral block in video-assisted thoracoscopic surgery: A double-blind randomized controlled trial.

Local anaesthetic adjuvants have been shown to provide better pain relief and extend the duration of analgesia. But little information is available on which adjuvants are more effective in block extension for thoracic paravertebral block (TPVB) during video-assisted thoracoscopic surgery (VATS). This study aimed to compare the analgesic efficacies of different adjuvants with 0.375% ropivacaine in ultrasound-guided TPVB for VATS. A total of 120 patients who underwent VATS at the study hospital in 2022-2023 were recruited and randomly divided into four groups, including the control group (Group R), which received 20 ml ropivacaine 0.375% for TPVB, and the intervention groups: Group D (0.375% ropivacaine with 1 µg/kg dexmedetomidine in a total of 20 ml for TPVB), group E (0.375% ropivacaine with 0.1 mg/kg dexamethasone in a total of 20 ml for TPVB), and group S (0.375% ropivacaine with 0.5ug/ml sufentanil in a total of 20 ml for TPVB). They received a single-injection ultrasound-guided unilateral T5-level TPVB. The primary clinical outcomes were visual analogue scale (VAS) pain scores at rest and during coughing at 4, 8, 12, 16, 20, 24, and 48 h postoperatively. Secondary outcomes included opioid consumption, number of patient-controlled intravenous analgesics (PCIA) used within 48 h, postoperative rescue analgesia, side effects, quality of recovery after surgery, and length of hospital stay. We found that the VAS pain scores in the resting state during the postoperative period at 12-20 h were lower in Group D than in Group R (P < 0.05). The resting VAS pain scores of Groups E and S were lower than those of Group R during the postoperative period of 12-16 h (P < 0.05). Similar differences were observed in the pain scores during coughing at the same time points. Additionally, the co-administration of adjuvants with ropivacaine were associated with decreased consumption of postoperative opioids, less frequent PCIA use, and earlier time to ambulation. The intergroup pairwise comparisons showed that dexmedetomidine was more effective than dexamethasone and sufentanil in reducing additional postoperative analgesics, the length of chest tube placement and length of hospital stay. Subsequently, we administered questionnaires on the quality of recovery, which was positively correlated with the postoperative analgesic effect. These findings suggest that adjuvant analgesia for TPVB can improve postoperative pain in patients undergoing VATS. However, compared with dexamethasone and sufentanil, dexmedetomidine is more effective in extending the duration of analgesia, reducing the demand of postoperative analgesics, improving the quality of recovery at 48 h postoperatively and shorting the length of hospital stay.

Guidelines For Adult Pleural Fluid Effusion In Critical Care (With The Exception Of Purulent Pleurisy, Haemothorax And Neoplastic Effusions) $$.

Guidelines For Adult Pleural Fluid Effusion In Critical Care (With The Exception Of Purulent Pleurisy, Haemothorax And Neoplastic Effusions) $$.

Management for perioperative complications of diaphragmatic surgery in ovarian cancer at a Chinese tertiary cancer center.

Diaphragm is the common site of metastasis in advanced ovarian cancer. Diaphragmatic surgery is necessary to achieve complete resection. Relative complications also pose challenges to perioperative management. This study aims to explore the influencing factors and management strategies for perioperative complications of diaphragm surgery. This study retrospectively included 396 patients who underwent diaphragmatic surgery for advanced ovarian cancer at Fudan University Shanghai Cancer Center from July 2015 to June 2022. Diaphragm surgical methods were classified, and perioperative complications were regarded according to Memorial Sloan Kettering Cancer Center criteria. Clinical characteristics and perioperative complications were analyzed to find correlations to establish the nomogram. Among the 396 patients, 163 patients (41.2%) suffered from perioperative complications. Pleural effusion (33.1%) and pneumothorax (5.3%) were the most commonly reported. Patients with longer surgery duration (>3 hours) (p=0.003) and who underwent diaphragmatic incision surgery (p=0.004) had a higher incidence of postoperative complications. The incidence of postoperative pleural effusion was significantly higher in patients who underwent diaphragm full-thickness resection (49.3%) than diaphragmatic stripping (29.5%) (p=0.001), and patients who underwent diaphragm full-thickness resection are more likely to require drainage (p=0.001). Multi-variate analyses showed that stage IV tumor, long operation time, and diaphragm full-thickness resection are associated with postoperative pleural effusion. Pleural effusion is the most common complication of diaphragmatic surgery in patients with ovarian cancer. Routine placement of prophylactic chest tubes is not appropriate for all patients undergoing diaphragmatic surgery. Our nomogram could help to predict its risk and indicate prophylactic management.

Chest Tube Placement: Would You Want to be Awake for This?

Chest Tube Placement: Would You Want to be Awake for This?

Iatrogenic Traumatic Regional Pericarditis Secondary to Chest Tube Placement: A Case Report

Iatrogenic Traumatic Regional Pericarditis Secondary to Chest Tube Placement: A Case Report

Safety and feasibility of percutaneous pulsed electrical field ablation in multiple organs: A multi-center retrospective study☆.

Safety and feasibility of percutaneous pulsed electrical field ablation in multiple organs: A multi-center retrospective study☆.

Planning thoracoscopic segmentectomies with 3-dimensional reconstruction software improves outcomes.

We investigated whether preoperatively generated models of the anatomy of the lung using 3-dimensional (3D) reconstruction software based on high-resolution computed tomography scans improve surgical and postoperative outcomes after video-assisted thoracoscopic surgery (VATS) segmentectomies. We retrospectively collected data from 100 consecutive patients who signed the general research consent form and underwent VATS segmentectomies between 2018 and 2023. The outcomes and complications of the operations planned with the 3D models were compared to the results of those performed without the models. We used propensity modelling and inverse probability of treatment weighting (IPTW) to analyse the data. Thirty-seven of the 100 patients included underwent surgery planned using the 3D models. In the 3D group, complex segmentectomies were performed more frequently (89% vs 38%, P < 0.001), and there were markedly fewer conversions to thoracotomy (P = 0.003). The IPTW analysis showed fewer severe complications (Clavien-Dindo grade III or IV) [post-IPTW odds ratio 0.10 (95% confidence interval 0.01-0.87), P = 0.037], and no Clavien-Dindo grade V complications occurred. Additionally, operative planning using models generated from 3D reconstruction software may influence procedural and postoperative parameters, such as the number of segments removed (1.9 ± 1.0 vs 1.7 ± 0.8, P = 0.40), duration of chest tube placement (3.0 days, interquartile range 2.0-4.0 vs 2.0 days, interquartile range 1.0-3.0, P = 0.060), and stay in the intensive/intermediate care unit. The planning of complex anatomical VATS segmentectomies using 3D models constructed from 3D reconstruction software significantly reduces the need for conversions to thoracotomy and postoperative complications rates. In addition, complex operations are thereby performed safely.

Subpleural injection of gelatin sponge particles to reduce pneumothorax incidence in CT-guided lung biopsies: a retrospective single-center case-control study

BackgroundTo evaluate the efficacy and safety of track sealing using subpleural injection of gelatin sponge particles in reducing the incidence of pneumothorax after percutaneous CT-guided lung biopsy.MethodsThis study conducted a retrospective analysis of 1,026 patients who underwent CT-guided lung biopsy at our center from January 2022 to July 2024. After propensity score matching (PSM) to minimize the impact of confounding variables like smoke, lesion diameter, and tract length, 338 patients were ultimately included and assigned to the sealant group (169 patients) or the non-sealing group (169 patients) according to whether using the gelatin sponge particles sealing after needle withdraw to the subpleural area. Clinical and operative characteristics data were collated from electronic medical records (EMR) and Picture Archiving and Communication Systems (PACS). A multivariable logistic regression analysis was conducted to identify predictors of pneumothorax.ResultsIn the sealing group, the incidence of pneumothorax was 14.8%, whereas it was significantly higher in the non-sealing group at 23.7% (p < 0.05). There was no significant difference in the chest tube placement rates of 3% and 1.8% (p = 0.723). Importantly, no significant complications, such as air embolism, were observed in either group. A multivariate logistic regression analysis, using a propensity score-matched cohort, identified patient emphysema (OR = 2.35 [1.22–4.51], p = 0.01) and the tract length (OR = 1.25 [1.01–1.55], p = 0.042) as significant risk factors for pneumothorax. Furthermore, gelatin sponge particle needle-tract sealing demonstrated a marked and statistically significant reduction in the risk of pneumothorax (OR = 0.5 [0.27–0.91], p = 0.024), highlighting the distinct advantages and clinical value of this treatment in preventing such complications.ConclusionsThe gelatin sponge particle subpleural sealing technique can effectively reduce the incidence of pneumothorax in patients undergoing percutaneous CT-guided lung biopsy.

Analysis of the safety and feasibility of sleeve resection under UniVATS after neoadjuvant chemotherapy combined with immunotherapy for locally advanced central-type non-small cell lung cancer

ObjectiveTo investigate the safety and feasibility of sleeve resection under Uni-VATS following neoadjuvant chemotherapy combined with immunotherapy for locally advanced central-type non-small cell lung cancer(NSCLC).MethodsWe analyzed 10 cIIB-IIIB NSCLC patients who underwent sleeve lung resection under single-port thoracoscopy from December 2022 to August 2023 after receiving platinum-based chemotherapy combined with albumin paclitaxel and programmed cell death protein-1 (PD-1) inhibitor drugs. Perioperative clinical data, side effects during neoadjuvant therapy, operation time, intraoperative blood loss, conversion rate to open thoracotomy, postoperative duration of chest tube placement, postoperative drainage volume, postoperative complications, and tumor outcomes were recorded.ResultsThis study included 10 patients. The preoperative clinical staging distribution was as follows: Stage IIB, 1 case; Stage IIIA, 5 cases; and Stage IIIB, 4 cases. Imaging evaluation after neoadjuvant therapy revealed that none of the patients achieved complete remission, whereas partial remission and stable disease were observed in 7 cases and 3 cases, respectively. All patients successfully underwent surgery, of which 2 patients required conversion to open thoracotomy (conversion rate, 20%) and 8 patients underwent single-port thoracoscopic minimally invasive surgery. Notably, 2 patients underwent sleeve resection of the right upper lobe, 2 patients underwent sleeve resection of the right middle and lower lobes, 2 patients underwent sleeve resection of the left upper lobe, and 4 patients underwent sleeve resection of the left lower lobe. The average operation time was 236 ± 87.7 min, the average intraoperative blood loss was 168 ± 62.5 mL, the average duration of chest tube placement was 5 days, the average total drainage volume was 1012 ± 464 mL, and the average hospitalization duration was 7 days. One patient developed encapsulated pleural effusion after surgery and underwent computed tomography (CT)-guided puncture drainage. At the 3-month and 6-month follow-up visits, no patient reported any particular discomfort, and chest radiography and CT revealed no abnormalities or signs of tumor recurrence.ConclusionSleeve resection after neoadjuvant chemotherapy combined with immunotherapy for locally advanced central-type NSCLC under single-port thoracoscopy is safe and feasible and provides short-term postoperative benefits for patients.

Accuracy, reliability, and utility of the extended focused assessment with sonography in trauma examination in the setting of thoracic gunshot wounds.

The extended focused assessment with sonography in trauma (eFAST) examination includes additional thoracic views beyond the standard focused assessment with sonography in trauma examination. Its validation has predominantly been conducted in blunt trauma cases. Our aim was to evaluate the eFAST examination in a targeted population with penetrating thoracic trauma. Patients with thoracic gunshot wounds who underwent eFAST between 2017 and 2021 were included from a local trauma registry. Performance metrics for each component of eFAST in each window and pathological condition were analyzed across the entire population, as well as within two cohorts: survived and deceased patients. Chest tube placement rates were compared within true-positive and false-negative (FN) eFAST results for subgroups with pneumothorax or hemothorax. A total of 288 patients were included (male, 91% male; Injury Severity Score ≥15, 48%; and died, 17%). Thirty-nine percent required chest tube, and 18% required urgent thoracic surgical intervention. Although specificity was high (91-100%) for all components, the sensitivity was less than 50% for all thoracic views, except for "no cardiac motion" (100% sensitivity). Sensitivity for pericardial fluid was 47%; for pneumothorax, 22%; for hemothorax, 36%; and for peritoneal fluid, 51% in the total population. Comparing survived versus deceased cohort, the eFAST sensitivity was higher among deaths for all components. The majority of patients (>70%) with a FN eFAST for pneumothorax or hemothorax received chest tube. The eFAST examination showed highly variable performance metrics among patients with penetrating thoracic trauma, with all thoracic components demonstrating high specificity but low overall sensitivity. Urgent interventions were frequently received in patients with FN studies. Prognostic and Epidemiological; Level IV.

How safe is it to discharge home patients with a chest tube in place? A narrative review of the literature.

In a time of particular focus on healthcare costs and quality metrics, combined with widespread embracing of the Early Recovery After Surgery approach, an outpatient setting for the management of prolonged air leak or excessive fluid drainage appears to be an acceptable option. The aim of this review is to evaluate the safety, efficacy and financial benefit of discharging home patients with chest tube after lung surgery or following chest drain insertion due to a pneumothorax. We reviewed the current literature analysing all available full-text papers published in English (PubMed, Cochrane and EMBASE databases). Data were reported as descriptive narrative. Our findings show that discharging home patients with chest tube in situ has not only a positive impact on length of stay but it also seems to be cost-effective. In our literature review, contrasting results have emerged regarding readmission rates and development of complications, especially empyema. Thus, outpatients management of patients discharged with a chest drain is feasible and cost-effective. A standardization of follow-up with dedicated ambulatory setting might improve patients' safety and increase this practice amongst thoracic surgery institutions.

Complicated pneumonia requiring invasive procedures in children in the post-COVID period: monocentric experience.

The Severe Acute Respiratory Syndrome virus (SARS-CoV-2) had a great impact in the worldwide population. Because of personal protective equipment (PPE), children have not been exposed to the commonly circulating respiratory viruses, with an effect on pneumonia disease spreading. The aim of our study was to evaluate the different distribution of invasive procedures for complicated pneumonia in pre, intra and post pandemic period. We conducted a retrospective analysis in children who underwent invasive procedures for complicated pneumonia, focusing on the winter season. Three periods were identified: pre-SARS-CoV-2 (14 months), pandemic (11 months) and post-SARS-CoV-2 (5 months). The invasive procedures considered were thoracentesis, chest tube placement, and video-assisted thoracoscopic surgery (VATS). A total of 67 children were admitted to our Institution for complicated pneumonia between November 2017 and March 2023 with a mean of 2.6, 1 and 4.4 per months respectively, in pre-pandemic and post-SARS-CoV-2. A chest tube was placed in 24% of pre-pandemic patients, 9% of pandemic and 50% of post-pandemic (P=0.002). Fifty percent of post-pandemic patients required VATS (P=0.014). Chest CT scans demonstrated necrotizing pneumonia with higher frequency in post-SARS-CoV-2 period (P=0.031). PPE preserved from SARS-CoV-2 but influenced the spread of other pathogens. We reported an increasing number of complicated pneumonias requiring surgery and of necrotizing pneumonia in the post-pandemic period.

Comparison of Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block with Local Anesthetic Infiltration Wound Site in Patients Undergoing Posterolateral Thoracotomy

Objective: To compare the effects of preoperative ultrasound-guided Erector spinae plane block with local anesthetic wound site infiltration on postoperative pain score and opioid consumption in patients undergoing posterolateral thoracotomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anesthesia and Pain Management Combined Military Hospital, Multan Pakistan from Dec 2022 to May 2023. Methodology: Sixty adult patients undergoing posterolateral thoracotomy were allocated randomly in two Groups, Erector spinae plane block Group X (n=30) and wound infiltration Group Y (n=30). In the ultrasound-guided Erector spinae plane block Group, Erector spinae plane block was performed with 0.5% Bupivacaine 20 ml at the level of thoracic vertebrae 5. In contrast, in the Wound Infiltration Group, 20 ml of 0.5% Bupivacaine was injected along the line of the surgical incision and also at the site of chest tube placement postoperatively. The postoperative opioid consumption and mean pain score at 01 hours, 06 hours, 12 hours, and at 24 hourS were assessed. Results: Compared with the wound site infiltration Group, the mean Pain scores at 1 hour, 06 hours, 12 hours, and 24 hours were significantly less in the ESPB Group (p&lt;0.001). Moreover, postoperative opioid consumption in the Erector spinae plane block Group was also significantly reduced postoperatively. Conclusion: Compared to wound infiltration with local anesthetics, Ultrasound-guided erector spinae block could significantly reduce the postoperative pain score opioid consumption and reduce the incidence of opioids induced complications in patients undergoing thoracotomy.

Prevalence and recurrence rates of spontaneous pneumothorax in patients with diffuse cystic lung diseases in China

ObjectivesTo investigate the prevalence and recurrence rates of spontaneous pneumothorax (SP) in patients with diffuse cystic lung diseases (DCLDs).MethodsWe retrospectively identified and analyzed medical records of patients with DCLDs encountered at the First Affiliated Hospital of University of Science and Technology of China from Jan 1, 2017 to December 31, 2023.ResultsA total of 289 patients were identified with DCLDs; 212 females and 77 males, with a median age of 48 years (range, 18–81 years). Among them, 89 (31%) patients had experienced SP; 59% among 115 patients with Birt-Hogg-Dubé (BHD), 34% of 41 patients with lymphangioleiomyomatosis (LAM, all women), 36% of 11 patients with pulmonary Langerhans cell histiocytosis (PLCH), none of 57 patients with Sjögren’s syndrome-associated diffuse cystic lung disease (SS-DCLD), and 5% of 65 patients with no identifiable underlying disease (χ² = 90.585, P < 0.001). The overall recurrence rate of SP was higher with observation or chest tube placement strategy compared to surgical intervention, 59% vs. 11% (P < 0.001, 95% CI [0.1, -0.4]), respectively. The recurrence rate after surgical management was significantly lower compared to conservative management in patients with BHD (10% vs. 69%, P < 0.001, 95% CI [0.1, 0.3]) and LAM (20% vs. 57%, P = 0.322, 95% CI [0.1, 2.1]). Among patients with BHD, LAM, and PLCH, those who had pneumothorax as the initial presentation were diagnosed of their underlying disease at a significantly younger age (42.2 ± 13.0 years) compared to those without pneumothorax (48.1 ± 11.8 years) (P = 0.032, 95% CI [-8.24, -0.36]). Notably, eight of LAM patients who were treated with sirolimus after the initial SP did not experience recurrence of SP.ConclusionThe risk of SP secondary to DCLDs was highest in patients with BHD, followed by those with PLCH and LAM. It was extremely low in SS-DCLD. Pneumothorax as the initial presentation often facilitated diagnosis of the underlying disease. Surgical treatment was associated with a lower recurrence rate of SP compared to nonsurgical management. In addition, sirolimus therapy may reduce the risk of pneumothorax recurrence in patients with LAM.

Robot-Assisted Thoracoscopic Surgery Can Be Safely Performed in Patients With Obesity from the Early Stages of Implementation.

This study aimed to compare the perioperative outcomes of robot-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) for lung cancer in patients with obesity. Anatomical pulmonary lobectomy or segmentectomy performed at a single institution from April 2018 to September 2023 in patients with obesity (body mass index ≥25 kg/m2) were statistically compared in terms of perioperative clinical factors including operative time, blood loss, chest tube duration, pain score, intraoperative events, and early postoperative complications between RATS and VATS. In all, 89 patients were evaluated; 43 underwent RATS and 46 underwent VATS. All RATS procedures were performed using the da Vinci Xi system. Patient characteristics were comparable between the 2 groups. The operative time, blood loss, number of dissected lymph nodes, intraoperative events, and conversion rate to open thoracotomy were similar between the 2 groups. The frequencies of postoperative complications and chest tube placement duration between the groups were also similar. The median pain scores were slightly higher in the RATS group on postoperative day 1 but were equivalent between the 2 groups on postoperative day 7. The RATS group had a shorter postoperative hospital stay than the VATS group (P < 0.01). A surgical team proficient in conventional VATS can safely introduce RATS in patients with obesity and lung cancer with equivalent perioperative outcomes.

Outcomes of CT-Guided Percutaneous Transthoracic Needle Biopsy of Cavitary Pulmonary Nodules.

Outcomes of CT-Guided Percutaneous Transthoracic Needle Biopsy of Cavitary Pulmonary Nodules.

Sarcoidosis Presenting as a Giant Pulmonary Bulla With Concurrent COVID-19 Infection.

Sarcoidosis is a systemic granulomatous disease that predominantly affects the lungs. However, its presentation as a giant pulmonary bulla is exceptionally rare. Its association with COVID-19 has raised new concerns regarding disease exacerbation and misdiagnosis. We report a case of a 38-year-old man who developed a large left lower lobe bulla in the context of recent COVID-19 infection. Initial misinterpretation of the bulla as loculated pneumothorax nearly led to an unnecessary chest tube placement. A subsequent thoracotomy with lobectomy revealed nonnecrotizing granulomas, confirming sarcoidosis. The patient showed spontaneous remission without requiring treatment. This case highlights the importance of multidisciplinary discussions in atypical lung presentations to prevent mismanagement.

Risk Factors and Outcomes of Invasive Candida Infections in Heart Transplant Recipients: A Case-Control Study.

Invasive Candida infections (ICI) are the most common invasive fungal infections in solid organ transplant recipients. There are limited contemporary data on the risk factors for infection in heart transplant (HT) recipients especially since the expansion of temporary mechanical circulatory support (MCS) use. This was a case-control study conducted at a tertiary care academic hospital of HT recipients from January 2022 to January 2024. All patients who developed ICI by the detection of Candida species from a normally sterile site were included as cases. Four controls who underwent HT, two before the case and two after the case, were selected. ​Fisher's exact or Mann-U-Whitney tests were used for the analysis. There were 12 cases and 48 controls out of a total of 117 transplants during the study period​. The proportion of ICI was 10.6%. The median time to ICI from transplant was 16 days (IQR 10, 83). The most common organisms isolated were Candida parapsilosis and Candida albicans. The majority of infections were mediastinitis. Risk factors for ICI included receipt of antibiotics for more than 7 days within 1 month prior to transplant (58.3%vs. 22.9%, p = 0.03), tracheostomy (41.7%vs. 10.4%, p = 0.02), prolonged chest tube placement (13vs. 9 days, p = 0.02), and temporary MCS (p = 0.042). Patients who developed ICI had increased 90-day all-cause mortality compared to controls (33.3% vs. 4.2%, p = 0.01). This study identified several risk factors for ICI following HT. Further research is essential to develop interventions that mitigate these risk factors in this patient population.

Medical thoracoscopy combined with intrapleural injection of urokinase for treatment of pleural infection-a multicenter, prospective, randomized controlled study: study protocol

BackgroundPleural diseases is a common respiratory disorder, mainly characterized as pleural effusion and patients with pleural effusion caused by pneumonia and empyema constituted 29% of the cohort, which suggests pleural infection as the predominant etiology of pleural effusion in China. Medical thoracoscopy (MT) combined with intrapleural injection of Urokinase holds significant therapeutic value for patients with early to moderate-stage empyema. However, there remains a lack of high-quality evidence regarding the efficacy and safety of combining MT with intrapleural injection of Urokinase administration in patients with pleural infections.MethodsThis study is a prospective, multicenter, randomized controlled clinical trial involving patients with pleural infections. The intervention involves medical thoracoscopy. The control group receives conventional treatment involving intrapleural urokinase injection followed by chest tube placement for drainage. The study outcomes include efficacy and health economic benefits. The estimated minimum sample size for each group is 64 cases, totaling 128 cases. The study groups are delineated as follows: patients in group A receives intrapleural urokinase injection followed by chest tube placement for drainage, while patients in group B undergoes MT to remove multiple septa and necrotic tissue followed by chest tube placement for drainage, and then intrapleural urokinase injection the day after MT. It is recommended that the diameter of the chest tube be 12–14 F, with three daily flushes of 30 ml normal saline to ensure optimal drainage. Subsequently, comprehensive statistical analyses will be conducted to compare treatment effects and complications across all groups, ultimately leading to conclusive findings.DiscussionThe study is the first prospective, multicenter clinical trial on the efficacy and safety of medical thoracoscopy combined with intrapleural urokinase injection for the treatment of pleural infection. This study aims to offer clinical guidance for the management of pleural infection.Registration numberChiCTR2300078352 (Registration Date: 2023/12/06).