Irrigation of infected pleural space with antiseptic solution: randomized trial

Abstract

<bold>Background:</bold> Studies in pleural infection showed that pleural irrigation with saline enhanced fluid drainage and reduced need for surgery. Antiseptic povidone-iodine irrigation was associated with good outcomes in case reports. The study aimed to investigate the effect of antiseptic irrigation on the inflammatory response, duration of chest tube placement and length of hospital stay (LOS) in patients with acute pleural infection. <bold>Methods:</bold> this is a randomised controlled trial; patients had either 250 ml povidone-iodine 2% irrigation (group 1) or 250 ml saline irrigation (group 2) twice daily for 3 days. The tube was clamped for 15 min after irrigation followed by free drainage. Pre and post irrigation blood inflammatory markers were recorded. The primary outcome was the degree of decrease of inflammatory markers after irrigation in study groups. <bold>Results:</bold> The study randomised 12 patients to group 1 (mean age 55.3+16.8, 9/12 males) and 9 patients to group 2 (mean age 47.3+18.6, 6/9 males). The decrease in blood CRP was higher in group 1 (median 67 mg/l [27.8 – 114]) than in group 2 (32 [-21.8-142]) but this was not statistically significant(P=0.509). The serum procalcitonin decrease in both groups was 0.1 [-0.04- 0.01] and 0.03 [-0.07- 0.09] respectively (P=0.593). Time for tube removal in group 1 was 10.2+1.7 days, and 9.3+1.7 days in group 2(P=0.206), LOS in group 1 was 12.5+2.8 days, 13.1+5.7 days in group 2 (P=0.775). Referral to surgery or death happened in 2/12 in group 1, 2/9 in group 2 (P=0.748). <bold>Conclusion:</bold> In comparison to saline irrigation, povidone-iodine irrigation showed a higher decrease in inflammatory markers which was not statistically significant. No differences were seen in other outcomes.