Evaluation of Thoracic Ultrasound in Monitoring Pleural Drainage in Postoperative Thoracic Surgery

Study Overview
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Brief Summary
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The investigator would like to conduct a study in patients undergoing thoracic surgery to evaluate the effectiveness of thoracic ultrasound in the decision to discharge the patient after pleural drain removal.

Detailed Description
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Thoracic drainage is a common and almost systematic practice after thoracic surgery requiring daily management and monitoring until and after its removal. It allows, after opening the pleura, the evacuation of liquid and/or air retained in the pleural cavity. The overall monitoring of the patient after thoracic surgery is based on clinical vigilance combined with thoracic imaging, in particular the chest X-ray which remains the Gold Standard (reference examination). The removal of the drain is decided according to the quantity and appearance of the evacuated fluid, the persistence of air leaks, etc… A few hours after the removal of the drain, it is routine to perform a chest X-ray before authorizing a possible discharge from the department. This practice does not correspond to an established scientific protocol but is systematically performed in our department before discharge. Several studies have defended the place of ultrasound in thoracic imaging and its contribution to the detection of postoperative and intensive care complications. Unlike radiography, this technique is non-irradiating, less expensive and more readily available. It allows the detection of pneumothorax, pleural effusions and other complications detectable on X-ray. To our knowledge, the contribution of thoracic ultrasound has not been studied in the decision to authorize the discharge of the patient after removal of the thoracic drain.

Official Title
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Evaluation of Thoracic Ultrasound in Monitoring Pleural Drainage in Postoperative Thoracic Surgery

Conditions
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Thoracic Ultrasound, Pleural Drain Removal

Intervention / Treatment
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* Procedure: Thoracic ultrasound versus chest X-ray


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing thoracic surgery (lung resection, pleural symphysis, biopsy or resection of a mediastinal tumor or ganglion, pleural decortication/decalcification) admitted immediately after surgery in the thoracic surgery department (standard care or continuous care) of the University Hospital of Limoges. Exclusion Criteria: Admission to the intensive care unit after thoracic surgery. Pneumonectomy Chest wall surgery Patients <18 years old Not affiliated to social security Under guardianship or curatorship Pregnant women Not knowing the French language

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
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: All patients<br> | Procedure: Thoracic ultrasound versus chest X-ray<br>* Perform un ultrasound test, in addition to Chest X-Ray (usual practice), few hours after the surgery (D0), the next day (D1) and 4 to 6 hours after drain removal. The data are collected in the standardized protocol for the two type of imaging. The thoracic ultrasound and the Chest X-Ray are performed, blindly each other, in the same position for the patient and the same suction level of drain.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Theoretical patient discharge | Theoretical patient discharge based on imaging data (pleural ultrasound or chest x-ray): YES: Score ≤ 2 on each of the 4 items assessed AND total score ≤ 4. NO: Score ≥ 3 on each of the items assessed and/or total score ≥ 5. | At the study completion, an average of 10 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain du to examination | To compare the pain generated by each examination (thoracic radiography and pleural ultrasound) with Visual Analogic Scale (0 to 10) at Day 0, Day 1 and post-drainage) | Day 0, Day 1 and At the study completion, an average of 10 days | 
| Subcutaneous emphysema | Evaluation of the concordance of pleural ultrasound data and chest radiography on the presence of subcutaneous emphysema at D0, D1 and post drain removal. | Day 0, Day 1 and At the study completion, an average of 10 days | 
| Pneumothorax | Evaluation of the concordance of pleural ultrasound data and chest radiography on the presence of Pneumothorax at D0, D1 and post drain removal. | Day 0, Day 1 and At the study completion, an average of 10 days | 
| Pleural effusion | Evaluation of the concordance of pleural ultrasound data and chest radiography on the presence of Pleural effusion at D0, D1 and post drain removal. | Day 0, Day 1 and At the study completion, an average of 10 days | 
| Pulmonary Condensation | Evaluation of the concordance of pleural ultrasound data and chest radiography on the presence of Pulmonary Condensation at D0, D1 and post drain removal. | Day 0, Day 1 and At the study completion, an average of 10 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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postoperative thoracic surgery, discharge decision, thoracic ultrasound, pleural drain removal, chest X-ray, thoracic surgery monitoring