SONO-DRAIN
Research type
Research Study
Full title
The effect of sonographic septations on the drainage of septated pleural effusions
IRAS ID
275515
Contact name
N/A CTRG
Contact email
Sponsor organisation
University of Oxford / Clinical Trials and Research Governance
Duration of Study in the UK
0 years, 10 months, 1 days
Research summary
Research Summary
As many as half of people who develop chest infections can get fluid buildup around the lung, known as pleural effusion. When the fluid itself becomes infected, this becomes known as pleural infection. The aim of this study is to investigate the effect that septations have on the drainage of pleural effusion. Septations are thin, strand like structures that are commonly seen within infected fluid or pleural fluid building up as a result of cancer. These strands, depending on how thick they are, can cause the fluid to 'wall off' into separate compartments, forming into 'pockets'. The reason septations are particularly relevant in pleural infection, is that they are assumed to impair drainage. This is often to a degree where clinicians may consider referring straight to surgery or giving clot busting medication through the chest tube being used to drain, which is not without some risk and considerable expense. The current medical literature does not tell us what the significance of septations is with regard to pleural fluid drainage and whether or not we should be managing these patients differently. I plan to begin to explore this issue by using detailed ultrasound assessments on patients while they are being drained to visualise what is happening to the fluid, whehther there is any communication between pockets, whether certain degrees of septations behave differently and correlate this with overall drainage volume.
Summary of Results
Septations in pleural effusions form as a result of inflammation activity in the pleural space, which can be due to a number of causes, but predominantly by infection or a type of cancer. It is unclear how the presence of septations should affect our treatment of these conditions that cause them. Their presence is assumed to always equate to poor drainage leading clinicians to sometimes take unnecessary interventions such as injecting blood thinning medications through a chest tube or referral to surgery. These interventions carry significant risk and expense and may not necessarily always be indicated.
We think there are other factors such as degree of septation, number of septations and whether or not there is any communication between these septations or ‘pockets’ that may be important. At present, the published research in this area is sparse. Through direct visualisation of what is happening in the pleural space using ultrasound enhanced by a contrast (dye) agent inject into the chest tube we have found that this technique is firstly safe, feasible for doctors treating this condition to perform with relative ease and is potentially effective at demonstrating drainage success early on in the treatment course.REC name
Wales REC 7
REC reference
20/WA/0291
Date of REC Opinion
12 Nov 2020
REC opinion
Further Information Favourable Opinion