- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05819294
Diagnostic Yield of Agitated Exudative Non-infected Pleural Effusion
A Feasibility Study of the Diagnostic Yield of Pre-aspiration Pleural Fluid Agitation in Non-infected Pleural Effusion
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Transudation or exudation are the two mechanisms by which fluid accumulates, where Starling forces' imbalance is responsible for the former and inflammatory increase in capillary permeability accounts for the latter. Despite the history and presentation commonly suggesting the underlying etiology, pleural fluid aspiration and analysis is frequently required for confirmation of the nature and cause of the effusion. Aspirated pleural fluid is routinely subjected to biochemical analysis as well as microbiological and cytological analysis especially when infection or neoplasia is suspected. One drawback however to thoracentesis analysis is the relatively low diagnostic yield in different forms of exudative effusion. Tuberculous pleural effusions have a yield of <10% on acid-fast bacilli smears and overall yield <30% on solid culture. Conventional cytologic analysis from malignant pleural effusions also show a relatively low overall yield of around 51%, though this could be highly variable depending on the primary cancer involved (6% in mesothelioma - 80% in ovarian adenocarcinoma).In addition, it is not uncommon for analysis results to widely vary in the same patient in those with loculated and in malignant pleural effusions. This could be attributed to the compartmentalization in complex septated collections and heterogenous distribution of cellular components throughout the pleural space. The gold standard however in diagnosing unexplained exudative pleural effusions is pleural biopsy which is technically demanding and sometimes associated with longer hospital stay along with the increased incurred costs.
The investigators propose a method for improving the representativeness of pleural fluid samples via pleural agitation prior to aspiration in exudative noninfected pleural effusion. The aim is to test the feasibility and safety of using pleural fluid agitation prior to aspiration and to investigate the potential for an improved diagnostic yield using this novel thoracentesis technique in patients with exudative non-infected pleural effusion. A control group of 10 participants with transudative pleural effusion (based on history, clinical picture, and imaging) will be included to exclude any effect of the agitation procedure on the biochemical profile of the pleural fluid. These will include patients with uncontrolled heart failure, renal or hepatic impairment presenting with classical uncomplicated free pleural effusion.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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-
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Alexandria, Egypt
- Chest Diseases Department, Alexandria University Faculty of Medicine
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age > 18 years old
- At least a moderate amount of pleural fluid collection (2 or more intercostal spaces on thoracic ultrasound)
Exclusion Criteria:
- Minimal - mild pleural fluid deemed unsuitable for aspiration and agitation
- Hemodynamic instability
- 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, positive gram stain or bacterial culture or pus on aspiration
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Standard thoracentesis followed by pre-aspiration fluid agitation
Participants will undergo the standard thoracentesis followed by the experimental pre-aspiration fluid agitation technique
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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
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Diagnostic yield of the cytological analysis
Time Frame: 14 days
|
Percentage of samples with a positive cytological result among both aspiration techniques
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14 days
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Diagnostic yield of the microbiolocal analysis (mycobacterial / fungal)
Time Frame: 14 days
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Percentage of samples with a evidence of mycobacterial / fungal elements among both aspiration techniques
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14 days
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Incidence of adverse events with pre-aspiration fluid agitation
Time Frame: 14 days
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Percentage of patients with incidence of adverse events during or right after pre-aspiration fluid agitation including pneumothorax or significant pain or cough or oxygen desaturation
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14 days
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Protein level difference between both aspiration method
Time Frame: results within 1 day of sampling
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Difference in Protein levels in the aspirated fluid via both techniques
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results within 1 day of sampling
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Lactate dehydrogenase (LDH) level difference between both aspiration method
Time Frame: results within 1 day of sampling
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Difference in LDH levels in the aspirated fluid via both techniques
|
results within 1 day of sampling
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Glusose level difference between both aspiration method
Time Frame: results within 1 day of sampling
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Difference in glucose levels in the aspirated fluid via both techniques
|
results within 1 day of sampling
|
Neutrophilic count difference between both aspiration method
Time Frame: results within 1 day of sampling
|
Difference in neutrophilic count in the aspirated fluid via both techniques
|
results within 1 day of sampling
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Lymphocytic count difference between both aspiration method
Time Frame: results within 1 day of sampling
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Difference in lymphocytic count in the aspirated fluid via both techniques
|
results within 1 day of sampling
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 0305913
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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