Chest
Original ResearchInterventional PulmonologyThe Relationship Between Chest Tube Size and Clinical Outcome in Pleural Infection
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The MIST1 Trial
The MIST1 trial2 was a double-blind, placebo-controlled comparison of intrapleural streptokinase with placebo in pleural infection. Intrapleural streptokinase was shown not to improve outcome, and so the results relating to chest tube size are not confounded by a treatment effect. Four hundred fifty-four patients were recruited from 52 UK centers, including both general and teaching hospitals. Patients with pleural fluid that was macroscopically purulent, positive on culture for bacterial
Subjects
Detailed chest tube data, including exact tube size, were available on 405 (89%) of the 454 subjects (Table 1). Where tube size was not recorded, this was usually because the insertion had been by an admitting physician not involved in the trial. The distribution of the chest tube sizes used in the whole group and in the two insertion methodology subsets is shown in Table 2.
Primary Analysis
There was no difference in the frequency with which patients either died and/or required thoracic surgery at 12 months in
Discussion
Our study has shown that the clinical outcome in patients treated with different chest tube sizes for pleural infection is similar, but smaller-size tubes cause less pain.
This difference in pain is substantial and clinically significant. During chest tube insertion and while the tube was in situ, 22/41 (54%) of patients receiving a chest tube ≥ 15F experienced moderate/severe pain, compared with only 21/77 (27%) of patients treated with a tube < 15F (χ2, 1 df = 8.0, P = .005). Thus, 27% of
Conclusion
To our knowledge, this is the first prospective study to directly compare outcomes in pleural infection with different chest tube sizes. The results demonstrate that in a large cohort of patients with pleural infection treated with a range of chest tube sizes and different insertion techniques, smaller-size tubes, 14F or smaller (mostly guide-wire inserted), cause much less pain than larger-size tubes (mostly blunt-dissection inserted), without impairing clinical outcome. Should these results
Acknowledgments
Author contributions: Dr Rahman: contributed to data collection, analysis, study design and concept, and manuscript preparation and approved the final manuscript.
Dr Maskell: contributed to data collection, study design and concept, and manuscript preparation and approved the final manuscript.
Dr C. W. H. Davies: contributed to data collection, study design, and manuscript preparation and approved the final manuscript.
Ms Hedley: contributed to data collection and manuscript preparation and
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Funding/support: The study was funded through a Medical Research Council grant [G9721289].
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