Journal Club September 2022

A feasibility randomised trial comparing therapeutic thoracentesis to chest tube insertion for the management of pleural infection: results from the ACTion trial. 

Arnold DT, et al.

BMC Pulm Med. 2022

PMID: 36042460 

A randomised feasibility trial comparing chest tube insertion (standard care) to therapeutic thoracentesis (intervention). The COVID-19 pandemic had a substantial impact on recruitment with just 10 patients randomised. Patients randomised to TT had a significantly shorter overall mean hospital stay (5.4 days, SD 5.1) compared to the chest tube control group (13 days, SD 6.0), p = 0.04. A full scale trial is needed to establish the safety and efficacy of this approach.

Risk factors related to pleural empyema after talc slurry pleurodesis. 

D’Ambrosio PD, et al.

Clinics (Sao Paulo). eCollection 2022.

PMID: 36041370

In this single centre retrospective study 86 patients who had a talc pleurodesis were reviewed for any evidence of pleural infection afterwards. 23% of patients met their criteria for pleural infection within 30 days.

At multivariate analysis the only factor that was significant at predicting the risk of empyema was antibiotic use at the time of pleurodesis. Presumably because there was already co-existent pneumonia or pleural infection.

A trial of intra-pleural bacterial immunotherapy in malignant pleural mesothelioma (TILT) – a randomised feasibility study using the trial within a cohort (TwiC) methodology. 

Bibby AC, et al.

Pilot Feasibility Stud. 2022

PMID: 36057634

A novel trial in design and intervention. A trial within cohort was found not to be feasible in mesothelioma for various reasons- short life expectancy, patient support groups etc.

The relationship between chest tube position in the thoracic cavity and treatment failure in patients with pleural infection: a retrospective cohort study. 

Taniguchi J,  et al.

BMC Pulm Med.

PMID: 36127681 

A retrospective observational study to test the hypothesis that pleural fluid drainage might be affected by position in the chest wall. 87 patients with pleural empyema were recruited. The cohort was dicotomised into two groups depending on chest tube position: 41 with a chest tube below the 10th thoracic vertebra and 46 above. The primary outcome was treatment failure- a composite of mortality, need for thoracic surgery and need for additional pleural procedures.

The groups were well matched for important clinical features at baseline including the RAPID score. Although numbers are relatively small for an observational study the authors did not show a significant difference between the groups in terms of chest tube position.