Pleural Infection
Conditions
Brief summary
The goal of this study is to compare the microbiologic diagnostic yield of pre-aspiration agitated pleural fluid versus that of conventionally aspirated fluid in pleural infection patients. The main question it aims to answer is, whether fluid agitation helps to increase the microbiological yield.
Detailed description
In pleural infection, It is suggested that the bacteria being diagnostically targeted, might more likely be residing on the pleural surface with a better blood supply and nutrition rather than being planktonic in the acidic, glucose deficient pleural fluid. The investigators thus hypothesize that an agitation of the pleural fluid prior to sample aspiration would aid in achieving a better cellular representation of the pleural space. This could have the effect of washing bacterial cells off the pleural surface as well as moving sedimented cells in the aspirated sample. This study aims to investigate whether an increase in the microbiological yield for infected pleural fluid could be achieved by a pre-aspiration agitation of the pleural fluid which would have a positive effect on management and eventual patient outcomes. Adult participants with pleural infection will undergo thoracentesis via both the standard and agitated fluid techniques guided by thoracic ultrasound. Microbiological yields will be compared.
Interventions
PROCEDUREAgitated Pleural Fluid Thoracentesis
Using a 16-18 gauge cannula, a standard thoracentesis will be performed then a sample of pleural fluid will be aspirated and rapidly flushed into the pleural space and redrawn again for a few cycles before a sample is finally drawn into the collection syringe
Sponsors
Alexandria University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Masking description
Laboratory personnel responsible for the microbiological and biochemical analysis will be blinded to the identity of the paired samples.
Intervention model description
All participants will undergo both thoracentesis techniques; the standard and the experimental pre-aspiration agitated fluid techniques
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age \>18 years old 2. Pleural infection based on clinical presentation, imaging or laboratory investigations and pleural fluid examination showing glucose \< 40 mg/dL or pH \<7.2 with lower respiratory infection or pus on aspiration 3. At least a moderate amount of pleural fluid collection (2 or more intercostal spaces on thoracic ultrasound)
Exclusion criteria
1. Minimal - mild pleural fluid deemed unsuitable for aspiration and agitation 2. Hemodynamic instability 3. Uncorrected coagulopathy 4. Transudative or exudative lymphocytic pleural effusion on biochemical analysis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diagnostic yield of the microbiologic analysis | results within 1 week of sampling | Percentage of samples with a positive microbiologic result among both aspiration techniques |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| LDH level difference between both aspiration methods | results within 1 day of sampling | Difference in LDH levels in the aspirated fluid via both techniques |
| Glucose level difference between both aspiration methods | results within 1 day of sampling | Difference in glucose levels in the aspirated fluid via both techniques |
| Protein level difference between both aspiration methods | results within 1 day of sampling | Difference in protein levels in the aspirated fluid via both techniques |
| Neutrophilic count difference between both aspiration methods | results within 1 day of sampling | Difference in neutrophilic count in the aspirated fluid via both techniques |
| Lymphocytic count difference between both aspiration methods | results within 1 day of sampling | Difference in lymphocytic count in the aspirated fluid via both techniques |
Countries
Egypt
Outcome results
None listed