Pleural Effusions in Critical Care
Research type
Research Study
Full title
Pleural Effusions in Critical Care (PECC) is an observational trial into the evolution of pleural fluid development in critical care.
IRAS ID
151746
Contact name
Justin Kirk-Bayley
Contact email
Sponsor organisation
Royal Surrey County Hospital, Department of Research, Development & Innovations
Duration of Study in the UK
1 years, 0 months, 15 days
Research summary
Collections of fluid in the pleural space around the lung (Pleural effusions) are common in critically ill patients on mechanical ventilators for breathing failure. Prolonged mechanical ventilation is associated with many problems including pneumonia, psychological disturbance and muscle weakness. Interventions that speed up discontinuation of ventilator support would help to reduce these complications.
Pleural effusions affect breathing in several ways. The underlying lung can be compressed and collapse leading to less oxygen being extracted as blood passes through it; Outward pressure on the chest wall and diaphragm can impair the ability to inflate the lung; stretching of receptors in the lung and chest wall can give a subjective feeling of difficulty in breathing. Indeed in studies in non-Intensive care patients there is a universal improvement in the patient’s feeling of shortness of breath following the drainage of this fluid.
While there is data suggesting an improvement in oxygen levels in mechanically ventilated patients following the drainage of pleural fluid (thoracocentesis), no study has adequately shown that the risk of inserting a chest drain is outweighed by a clinical benefit to the patient in terms of their risk of death or the time they are exposed to mechanical ventilation.
This lack of consensus is confirmed by an absence of any national or international guidelines leaving clinicians with no clear evidence to decide on what the best course of action is in this situation. A study showing a meaningful improvement in terms of time on mechanical ventilation, rate of death or quality of life at six months would have a huge potential impact on a large number of NHS patients.
There is a consensus on the safest way to insert a chest drain with the appropriate use of ultrasound. As this is a specialist skill, the main aim of this feasibility study is to see if it is possible to recruit patients in a timely way and to examine the changes in pleural effusions over time. If this study demonstrates this feasibility then a larger multicentre study would be undertaken to examine if this intervention improves death rates and quality of life.
REC name
Wales REC 3
REC reference
14/WA/1206
Date of REC Opinion
13 Jan 2015
REC opinion
Further Information Favourable Opinion