Fluid Agitation Microbiologic Yield In Pleural Infection Feasibility Study

Study Overview
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Brief Summary
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The goal of this study is to compare the microbiologic diagnostic yield of pre-aspiration agitated pleural fluid versus that of conventionally aspirated fluid in pleural infection patients. The main question it aims to answer is, whether fluid agitation helps to increase the microbiological yield.

Detailed Description
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In pleural infection, It is suggested that the bacteria being diagnostically targeted, might more likely be residing on the pleural surface with a better blood supply and nutrition rather than being planktonic in the acidic, glucose deficient pleural fluid. The investigators thus hypothesize that an agitation of the pleural fluid prior to sample aspiration would aid in achieving a better cellular representation of the pleural space. This could have the effect of washing bacterial cells off the pleural surface as well as moving sedimented cells in the aspirated sample. This study aims to investigate whether an increase in the microbiological yield for infected pleural fluid could be achieved by a pre-aspiration agitation of the pleural fluid which would have a positive effect on management and eventual patient outcomes. Adult participants with pleural infection will undergo thoracentesis via both the standard and agitated fluid techniques guided by thoracic ultrasound. Microbiological yields will be compared.

Official Title
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Pleural Fluid Agitation For Improving The Microbiologic Diagnostic Yield In Pleural Infection - A Comparative Feasibility Study

Conditions
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Pleural Infection

Intervention / Treatment
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* Procedure: Agitated Pleural Fluid Thoracentesis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age >18 years old 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 or pus on aspiration 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 Uncorrected coagulopathy Transudative or exudative lymphocytic pleural effusion on biochemical analysis

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Interventional Model Description: All participants will undergo both thoracentesis techniques; the standard and the experimental pre-aspiration agitated fluid techniques
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Standard thoracentesis followed by pre-aspiration fluid agitation<br>Participants will undergo the standard thoracentesis followed by the experimental pre-aspiration fluid agitation technique | Procedure: Agitated Pleural Fluid Thoracentesis<br>* 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<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diagnostic yield of the microbiologic analysis | Percentage of samples with a positive microbiologic result among both aspiration techniques | results within 1 week of sampling | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| LDH level difference between both aspiration methods | Difference in LDH levels in the aspirated fluid via both techniques | results within 1 day of sampling | 
| Glucose level difference between both aspiration methods | Difference in glucose levels in the aspirated fluid via both techniques | results within 1 day of sampling | 
| Protein level difference between both aspiration methods | Difference in protein levels in the aspirated fluid via both techniques | results within 1 day of sampling | 
| Neutrophilic count difference between both aspiration methods | Difference in neutrophilic count in the aspirated fluid via both techniques | results within 1 day of sampling | 
| Lymphocytic count difference between both aspiration methods | Difference in lymphocytic count in the aspirated fluid via both techniques | results within 1 day of sampling |