1
|
Mercer RM, Mishra E, Banka R, Corcoran JP, Daneshvar C, Panchal RK, Saba T, Caswell M, Johnstone S, Menzies D, Ahmer S, Shahidi M, Clive AO, Gautam M, Cox G, Orton C, Lyons J, Maddekar N, De Fonseka D, Prior K, Barnes S, Robinson G, Brown L, Munavvar M, Shah PL, Hallifax RJ, Blyth KG, Hedley E, Maskell NA, Gerry S, Miller RF, Rahman NM, Kemp SV. A randomised controlled trial of intrapleural balloon intercostal chest drains to prevent drain displacement. Eur Respir J 2021; 60:13993003.01753-2021. [PMID: 34949702 DOI: 10.1183/13993003.01753-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/23/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chest drain displacement is a common clinical problem, occurring in 9-42% of cases and results in treatment failure or additional pleural procedures conferring unnecessary risk. A novel chest drain with an integrated intrapleural balloon may reduce the risk of displacement. METHODS Prospective randomised controlled trial comparing the balloon drain to standard care (12 F chest drain with no balloon) with the primary outcome of objectively-defined unintentional or accidental chest drain displacement. RESULTS 267 patients were randomised (primary outcome data available in 257, 96.2%). Displacement occurred less frequently using the balloon drain (displacement 5/128, 3.9%; standard care displacement 13/129, 10.1%) but this was not statistically significant (Odds Ratio (OR) for drain displacement 0.36, 95% CI 0.13 to 1.0, χ2 1df=2.87, p=0.09). Adjusted analysis to account for minimisation factors and use of drain sutures demonstrated balloon drains were independently associated with reduced drain fall out rate (adjusted OR 0.27, 95% CI 0.08 to 0.87, p=0.028). Adverse events were higher in the balloon arm than the standard care arm (balloon drain 59/131, 45.0%; standard care 18/132, 13.6%; χ2 1df=31.3, p<0.0001). CONCLUSION Balloon drains reduce displacement compared with standard drains independent of the use of sutures but are associated with increased adverse events specifically during drain removal. The potential benefits of the novel drain should be weighed against the risks, but may be considered in practices where sutures are not routinely used.
Collapse
Affiliation(s)
- Rachel M Mercer
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Eleanor Mishra
- Department of Respiratory Medicine, Norfolk and Norwich University Hospitals, Norwich, UK
| | - Radhika Banka
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Respiratory Medicine, Norfolk and Norwich University Hospitals, Norwich, UK
| | | | | | - Rakesh K Panchal
- Institute for Lung Health, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Tarek Saba
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Melanie Caswell
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Sarah Johnstone
- Institute for Lung Health, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | | | - Amelia O Clive
- Academic Respiratory Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK
| | - Manish Gautam
- Department of Respiratory Medicine, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
| | | | | | - Judith Lyons
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Duneesha De Fonseka
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, Sheffield, UK
| | | | - Simon Barnes
- Somerset Lung Centre, Musgrove Park Hospital, Taunton, UK
| | | | - Louise Brown
- North Manchester General Hospital, Manchester, UK
| | | | - Palav L Shah
- Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Robert J Hallifax
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Kevin G Blyth
- Queen Elizabeth University Hospital, Glasgow/Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Emma Hedley
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK.,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK
| | - Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK
| | - Najib M Rahman
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK .,Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.,NMR and SVK contributed jointly
| | - Samuel V Kemp
- Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| |
Collapse
|