A Phase 2 interventional study of Pleural Saline Irrigation in Pleural Effusion Associated With Pulmonary Infection, Pleural Effusion Disorder and Pleural Effusions, sponsored by Beth Israel Deaconess Medical Center. Recruiting at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-08-28.
Sponsored by Beth Israel Deaconess Medical Center · Phase 2, Interventional, and Treatment
The purpose of this protocol is to conduct a pilot prospective non-blind clinical trial to evaluate the efficacy and safety of a novel saline irrigation technique as an adjunct to standard interventions for treating retained pleural infections. Intrapleural fibrinolytic therapy (IPFT) is commonly used for infections not adequately managed with antibiotics and intercostal tube drainage, while saline irrigation serves as an alternative for cases with a high bleeding risk where IPFT is not feasible. The efficacy of saline irrigation combined with IPFT remains unexplored. The hypothesis is that saline irrigation could be an effective and safe addition to IPFT for patients with persistent pleural infections.
The specific aims of the study include:
Determine the efficacy of saline irrigation as add-on therapy to IPFT: Compare the clinical outcomes of patients receiving saline irrigation combined with IPFT to those receiving IPFT alone to determine if the addition of saline irrigation offers significant benefits. Outcomes include changes in inflammatory markers, imaging characteristics (echography and CT), volume of pleural fluid drained, chest tube duration, hospital length of stay, and the need for subsequent surgical intervention.
Assess the safety and tolerability of saline irrigation plus IPFT: Compare complications and patient comfort in those receiving saline irrigation combined with IPFT to those receiving IPFT alone.
Objective:
To evaluate the efficacy and safety of pleural saline irrigation as an adjunct therapy in patients with retained pleural infection, comparing it with the standard of care (antibiotics, chest tube placement, and lytics).
Study Design:
This is a prospective, two-arm pilot trial to be conducted at Beth Israel Deaconess Medical Center. The study will involve two groups: one receiving standard care and the other receiving pleural saline irrigation in addition to standard care. Patients will be assigned to one of the two study arms (standard care vs. standard care + saline irrigation) using block randomization to ensure balanced group sizes.
Interventions:
Control Group (Standard Care):
Patients will receive the current standard of care, which includes antibiotics, chest tube placement, and intrapleural tPA/DNase therapy based on the criteria outlined above.
Intervention Group (Standard Care + Saline Irrigation):
In addition to the standard care, patients in this group will receive pleural saline irrigation through the chest tube immediately after IPFT. The amount of saline will be determined by free-flow saline infusion up to 250 mL. This maneuver will be repeated each time IPFT is administered, based on the treating physician's criteria.
Outcomes:
Primary Endpoint:
The primary outcome is the reduction in pleural effusion volume, measured with CT (volumetry) and US (Balik formula), with efficacy defined as a 10% or greater improvement compared to standard care alone. Success will be determined by a ≥10% additional reduction in pleural effusion volume compared to regular interventions.
Secondary Endpoints:
Rate of pleural infection resolution based on clinical (fever), radiographic (ultrasound and CT signs of complicated pleural effusion), and laboratory (inflammatory markers) data.
Chest tube duration. Duration of hospital stay. Complications related to the interventions. Pain associated with the interventions. Need for surgery. Overall mortality.
Data Collection and Variables:
A range of variables will be collected to assess both primary and secondary outcomes. Primary outcome measures will focus on the percentage reduction in pleural effusion volume, assessed through chest ultrasound or CT scan at baseline and during follow-up. Secondary outcomes include adverse events related to the intervention, such as hypothermia, chest discomfort, and fluid overload. The incidence of pleural infection-related complications, recurrence of infection, and the need for further pleural interventions, such as thoracentesis or chest tube placement, will be monitored. Chest tube duration, fever duration, leukocytosis, neutrophil count, and blood culture results will be evaluated to track infection resolution and patient recovery.
Subgroup analysis will be performed based on pleural fluid volume and characteristics (pH, glucose, LDH), antibiotic duration, and follow-up imaging results, both at the end of therapy and 3-6 weeks later. Other intervention-related variables, such as the amount and frequency of saline irrigation, chest tube size, intrapleural tPA/DNase doses, and the total volume of fluid drained, will also be collected to further assess the intervention's efficacy and safety.
241 studies on the registry are indexed under Pleural Effusion; 50 are open to participants now.
This study's planned enrollment of 96 is above the median of 80 across 142 interventional studies indexed under Pleural Effusion.
Browse Pleural Effusion studies →Beth Israel Deaconess Medical Center is the lead sponsor of 568 studies on the registry; 80 are open to participants now.
Of its 76 completed or terminated interventional studies of FDA-regulated products, 62 (82%) have results posted.
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Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.
Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Cancer (malignancy)
Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.
Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Patients will receive the current standard of care, which includes antibiotics, chest tube placement, and intrapleural tPA/DNase therapy based on their clinical criteria
In addition to the standard care, patients in this group will receive pleural saline irrigation through the chest tube immediately after IPFT. The amount of saline will be determined by free-flow saline infusion up to 250 mL. This maneuver will be repeated every time that IPFT is administered, based on treating physician's criteria
Combination Product: Pleural Saline Irrigation
This intervention, Pleural Saline Irrigation, involves the administration of up to 250 mL of sterile saline solution into the pleural cavity through a chest tube immediately following each intrapleural tPA/DNase (IPFT) therapy session. The saline irrigation is intended to aid in clearing infected pleural fluid and reducing pleural effusion volume. This maneuver is repeated based on the treating physician's criteria, differentiating it from standard care, which includes only antibiotics, chest tube placement, and IPFT without saline irrigation. The irrigation is expected to enhance infection resolution and may impact chest tube duration and the frequency of pleural interventions.
Reduction in Pleural Effusion Volume
This outcome assesses the percentage reduction in pleural effusion volume from baseline, measured by CT (volumetry) and ultrasound using the Balik formula. Efficacy is defined as a 10% or greater improvement in pleural effusion volume reduction in the intervention group (standard care plus pleural saline irrigation) compared to the control group (standard care alone). Success is determined by achieving a ≥10% additional reduction in pleural effusion volume in the intervention group compared to the control group, indicating a clinically meaningful improvement with adjunctive saline irrigation.
Time frame: Baseline (prior to intervention). During hospitalization (before each IPFT and irrigation session, anticipated every 24 hours, up to 14 days). At discharge (7-14 days post-intervention initiation). Follow-up at 3 weeks (+/- 3 days) and 6 weeks (+/- 3 day
Rate of pleural infection resolution
Determined through clinical markers (fever resolution), radiographic improvement (ultrasound and CT signs of effusion), and laboratory indicators (inflammatory markers and blood cultures).
Time frame: Baseline, at discharge (7-14 days post-intervention initiation), and follow-up (3 weeks +/- 3 days and 6 weeks +/- 3 days post-discharge).
Chest tube duration
Total duration of chest tube placement from insertion to removal.
Time frame: Through hospitalization (up to 14 days).
Length of hospital stay
Total length of stay from admission to discharge.
Time frame: Through hospitalization (anticipated 7-14 days).
Complications related to the interventions
Includes adverse events such as hypothermia, chest discomfort, fluid overload, and infection recurrence.
Time frame: During hospitalization (up to 14 days) and at follow-up (3 weeks +/- 3 days and 6 weeks +/- 3 days post-discharge).
Pain associated with interventions
Level of pain reported during procedures, measured using a standardized pain scale (e.g., Visual Analog Scale).
Time frame: During hospitalization (measured immediately after each intervention session, anticipated up to 14 days).
Need for surgical intervention
Incidence of surgical intervention required due to unresolved pleural infection or complications.
Time frame: Through study completion (up to 6 weeks post-discharge).
Overall mortality
Death from any cause during the study period.
Time frame: Through study completion (up to 6 weeks post-discharge).
Plan to share: Undecided
No publications or documents are linked to this record.
Started Apr 2025 (actual). Primary completion is estimated for Nov 2026, 19 months after the start.
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