ABSTRACT
Background: Pleural infection has a considerable healthcare burden with an average hospital stay of 14 days. There have been no randomised trials on the use of therapeutic thoracentesis (TT) for initial pleural fluid drainage. Aim(s): To assess the feasibility of a full-scale trial of chest tube vs TT for pleural infection. The primary outcome was defined as the acceptability of randomisation (ad priori defined as successful if >=50% of eligible patients were randomised). Method(s): Adult patients admitted with a pleural effusion related to infection and meeting recognised criteria for drainage were eligible. Participants were randomised (unblinded) to chest tube insertion or TT. Patients were followed up at 90 days. Result(s): From September 2019 and June 2021, 51 patients were diagnosed with complex parapneumonic effusion/empyema. Eleven patients met the inclusion criteria for trial and 10 patients were randomised (91%). The COVID-19 pandemic had a significant impact on recruitment. Patients randomised to TT had a shorter overall mean hospital stay (5.4 days, SD 5.1) compared to the chest tube control group (13 days, SD 6.0), p=0.04. Total number of pleural procedures required per patient were similar, 1.2 in chest tube group and 1.4 in TT group. No patients required surgical referral. Adverse events were similar between the groups with no readmissions related to pleural infection. Data completeness was high with no protocol deviations. Conclusion(s): The ACTion trial met its prespecified feasibility criteria for patient acceptability. The suggestion that TT can reduce hospital length of stay requires further investigation.
ABSTRACT
S38 Figure 1ConclusionsOmicron infection was associated with less severe illness compared to Delta infection across three separate measures of severity. COVID-19 vaccination was independently associated with lower in-hospital disease severity, regardless of variant. Lower severity of Omicron combined with the ability of vaccine to further reduce severity may result in reduced pressure on healthcare services;however, the increased transmissibility of Omicron and potential for higher numbers of infections, particularly in elderly patients, may mitigate these benefits.Please refer to page A208 for declarations of interest related to this .
ABSTRACT
S41 Figure 1ConclusionsWhile SARS-CoV-2 infection was a large component of hospitalised aLRTD, non-SARS-CoV-2 infection caused 56% of respiratory infection hospitalisations overall. Measured incidences of non-SARS-CoV-2 pneumonia and NP-LRTI were higher than pre-pandemic UK estimates. Given public health interventions to reduce all infective aLRTD implemented during this year, these higher estimates likely reflect highly comprehensive surveillance although there may have been a true higher non-SARS-CoV-2 disease incidence. These results demonstrate the significant burden of acute respiratory infection on healthcare systems. Broader efforts to prevent and manage all forms of adult aLRTD should be prioritized in addition to current COVID-19 prevention efforts.Please refer to page A209 for declarations of interest related to this .
ABSTRACT
IntroductionPleural effusion is common in lung cancer. Metastatic disease may be confirmed on imaging or fluid sampling. A minority of patients however with otherwise radically treatable disease have a small effusion not amenable to aspiration, or from which fluid cytology is negative;termed minimal pleural effusion (mini-PE). Previous retrospective studies associate significantly shorter survival in mini-PE than stage-matched cases without mini-PE and hypothesise this reflects occult pleural metastases (OPM) in up to 80% of patients. STRATIFY (Staging by Thoracoscopy in Potentially Radically Treatable Non-Small Cell Lung Cancer (NSCLC) Associated with Minimal Pleural Effusion) is a multicentre, prospective observational study, which will determine the true prevalence of OPM in this setting. An update on the study is provided here.MethodsSTRATIFY was funded by Chief Scientist Office and opened to recruitment in Jan-20. Target n=96 across 8 UK centres in 18 months. Key eligibility criteria include Mini-PE (defined by an ipsilateral effusion <1/3 hemithorax on chest radiograph), radically treatable NSCLC and LAT feasibility (defined by sufficient fluid ± lung sliding on screening ultrasound). Primary endpoint: Prevalence of OPM, defined as NSCLC cells in parietal pleural biopsies. Key secondary endpoints include LAT safety, the impact of LAT results on NSCLC treatment plans and non-invasive MRI-derived measures of cardiac function and altered body composition (as alternative explanations for mini-PE). Study progress, including the impact of COVID19 was reviewed and summarised.ResultsSTRATIFY was rapidly halted due to COVID19 after 1 patient was recruited. The study was allowed to reopen in July-20 but given a dramatic reduction in lung cancer referrals across the UK and delayed site set up processes, the study team took the decision to close recruitment from Oct-20 to Apr-21. This was supported by the funder who provided a costed 6-month extension. By June-21, 4/8 sites have opened. 4/6 six screened patients have been recruited, 2/4 have entered the MRI sub-study.ConclusionsSTRATIFY will determine the true prevalence of OPM in patients with radically treatable NSCLC and mini-PE. The study outcomes will be important in defining an extended role for LAT as a pleural staging tool.