A randomised controlled trial of the feasibility of early administration of clot-busting medication through a chest tube versus early surgery in pleural infection

2019 ◽  
Author(s):  
Eihab Bedawi
Keyword(s):  
Randomised Controlled Trial ◽  
Chest Tube ◽  
Controlled Trial ◽  
Early Surgery ◽  
Early Administration ◽  
Pleural Infection ◽  
Tube Versus ◽  
Randomised Controlled

scholarly journals Rationale and design of the HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) Trial: a protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e028537 ◽  
Author(s):  
Flavia K Borges ◽  
Mohit Bhandari ◽  
Ameen Patel ◽  
Victoria Avram ◽  
Ernesto Guerra-Farfán ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hip Fracture ◽  
Randomised Controlled Trial ◽  
Standard Care ◽  
Perioperative Complications ◽  
Public Awareness ◽  
Controlled Trial ◽  
Early Surgery ◽  
All Cause Mortality ◽  
Randomised Controlled

IntroductionAnnually, millions of adults suffer hip fractures. The mortality rate post a hip fracture is 7%–10% at 30 days and 10%–20% at 90 days. Observational data suggest that early surgery can improve these outcomes in hip fracture patients. We designed a clinical trial—HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) to determine the effect of accelerated surgery compared with standard care on the 90-day risk of all-cause mortality and major perioperative complications.Methods and analysisHIP ATTACK is a multicentre, international, parallel group randomised controlled trial (RCT) that will include patients ≥45 years of age and diagnosed with a hip fracture from a low-energy mechanism requiring surgery. Patients are randomised to accelerated medical assessment and surgical repair (goal within 6 h) or standard care. The co-primary outcomes are (1) all-cause mortality and (2) a composite of major perioperative complications (ie, mortality and non-fatal myocardial infarction, pulmonary embolism, pneumonia, sepsis, stroke, and life-threatening and major bleeding) at 90 days after randomisation. All patients will be followed up for a period of 1 year. We will enrol 3000 patients.Ethics and disseminationAll centres had ethics approval before randomising patients. Written informed consent is required for all patients before randomisation. HIP ATTACK is the first large international trial designed to examine whether accelerated surgery can improve outcomes in patients with a hip fracture. The dissemination plan includes publishing the results in a policy-influencing journal, conference presentations, engagement of influential medical organisations, and providing public awareness through multimedia resources.Trial registration numberNCT02027896; Pre-results.

scholarly journals Pleural irrigation trial (PIT): a randomised controlled trial of pleural irrigation with normal saline versus standard care in patients with pleural infection

2015 ◽  
Vol 46 (2) ◽  
pp. 456-463 ◽  
Author(s):  
Clare E. Hooper ◽  
Anthony J. Edey ◽  
Anthony Wallis ◽  
Amelia O. Clive ◽  
Anna Morley ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Randomised Controlled Trial ◽  
Adverse Events ◽  
Hospital Stay ◽  
Standard Care ◽  
Best Practice ◽  
Controlled Trial ◽  
Saline Irrigation ◽  
Pleural Infection ◽  
Randomised Controlled

Pleural infection is increasing in incidence. Despite optimal medical management, up to 30% of patients will die or require surgery. Case reports suggest that irrigation of the pleural space with saline may be beneficial.A randomised controlled pilot study in which saline pleural irrigation (three times per day for 3 days) plus best-practice management was compared with best-practice management alone was performed in patients with pleural infection requiring chest-tube drainage. The primary outcome was percentage change in computed tomography pleural fluid volume from day 0 to day 3. Secondary outcomes included surgical referral rate, hospital stay and adverse events.35 patients were randomised. Patients receiving saline irrigation had a significantly greater reduction in pleural collection volume on computed tomography compared to those receiving standard care (median (interquartile range) 32.3% (19.6–43.7%) reduction versus 15.3% (−5.5–28%) reduction) (p<0.04). Significantly fewer patients in the irrigation group were referred for surgery (OR 7.1, 95% CI 1.23–41.0; p=0.03). There was no difference in length of hospital stay, fall in C-reactive protein, white cell count or procalcitonin or adverse events between the treatment groups, and no serious complications were documented.Saline irrigation improves pleural fluid drainage and reduces referrals for surgery in pleural infection. A large multicentre randomised controlled trial is now warranted to evaluate its effects further.

scholarly journals Ambulatory management of secondary spontaneous pneumothorax: a randomised controlled trial

2020 ◽  
pp. 2003375
Author(s):  
Steven P Walker ◽  
Emma Keenan ◽  
Oliver Bintcliffe ◽  
Andrew E Stanton ◽  
Mark Roberts ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Treatment Failure ◽  
Early Treatment ◽  
Chest Tube ◽  
Standard Care ◽  
Spontaneous Pneumothorax ◽  
Controlled Trial ◽  
High Rate ◽  
Secondary Spontaneous Pneumothorax ◽  
Randomised Controlled

ObjectiveSecondary spontaneous pneumothorax (SSP) is traditionally managed with an intercostal chest tube attached to an underwater seal. We investigated whether use of a one-way flutter valve shortened length of patients’ stay (LoS).MethodsThis open-label randomised controlled trial enrolled patients presenting with SSP and randomised to either a chest tube and underwater seal (standard care: SC) or ambulatory care (AC) with a flutter valve. The type of flutter valve used depended on whether at randomisation the patient already had a chest tube in place: in those without a chest tube a Pleural Vent (PV) was used; in those with a chest tube in situ, an Atrium Pneumostat (AP) valve was attached. The primary end-point was LoS.ResultsBetween March 2017 and March 2020, 41 patients underwent randomisation: 20 to SC and 21 to AC (13=PV, 8=AP). There was no difference in LoS in the first 30 days following treatment intervention: AC (median=6 days, IQR 14.5) and SC (median=6 days, IQR 13.3). In patients treated with PV there was a high rate of early treatment failure (6/13; 46%), compared to patients receiving SC (3/20; 15%) (p=0.11) Patients treated with AP had no (0/8 0%) early treatment failures and a median LoS of 1.5 days (IQR 23.8).ConclusionThere was no difference in LoS between ambulatory and standard care. Pleural Vents had high rates of treatment failure and should not be used in SSP. Atrium Pneumostats are a safer alternative, with a trend towards lower LOS

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