acute empyema and complicated parapneumonic effusions
Conditions
Interventions
60 mL of sodium bicarbonate injection is administered into the pleural space via a double-lumen chest tube which is then clamped. Patient position is changed every 30 minutes. After 2 hours the clamp
Sponsors
Yamamoto Masaki
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Men and women who are at least 18 years old at the time of registration 2. Patients diagnosed with acute empyema and complicated parapneumonic effusions (diagnostic criteria: clinically evident bacterial infection with pleural effusion and one or more of the following. Imaging evidence of pleural effusion encapsulation, positive pleural fluid Gram stain or culture, pleural fluid pH 1000 IU/L, gross findings of pleural fluid is pus) 3. Administer antimicrobials and continuous thoracic drainage. Patients with residual pleural effusion on chest x-ray at least 12 hours after initiating continuous thoracic drainage (-10 cmH2O or above). 4. Patients who give written consent to participate in this study. Consent of a surrogate (spouse, guardian, or other equivalent) is also acceptable.
Exclusion criteria
Exclusion criteria: 1. Patients with fistulous empyema 2. Patients with renal dysfunction (estimated Clearatin clearance less than 30 ml/min) 3. Patients with severe cardiac disease in the past 4. Patients with congestive heart failure requiring treatment 5. Patients with a history of severe respiratory dysfunction 6. Patients with Coagulation Abnormalities or Patients on Anticoagulant Therapy PT-INR (Prothrombin Time-International Normalized Ratio): 1.5 or higher, or currently receiving anticoagulant therapy (excluding cases where therapy is suspended for continuous drainage). APTT (Activated Partial Thromboplastin Time): Prolongation of 1.5 times the upper limit of normal (ULN) or more, based on institutional standards. Platelet count: Less than 100,000/microL, or severe platelet dysfunction. Fibrinogen: Less than 200 mg/dL. 7. Patients with alkalemia (pH level of 7.45 or more on venous blood gas) 8. Patients with a serum sodium level of 150 mEq/L or more 9. Patients with a serum potassium level less than 3.0 mEq/L 10. Patients with a serum calcium level less than 8.0 mg/dL 11. Patients with septic shock 12. Pregnant or lactating women 13. Patients who have received unapproved drugs within 12 weeks 14. Other patients who are judged to be inappropriate by the physician
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Avoidance rate of surgery or death | — |
Secondary
| Measure | Time frame |
|---|---|
| Days with fever, days with chest drain, changes in chest X-ray findings, changes in white blood cell count, neutrophil count, and CRP | — |
Contacts
Public ContactMasaki Yamamoto
Yokohama City University Medical Center
Outcome results
None listed