Thoracic duct drainage for Pyemia

Phase-Based Progress Estimates
1
Effectiveness
1
Safety
University of Pennsylvania, Philadelphia, PA
Pyemia+3 More
Thoracic duct drainage - Procedure
Eligibility
18+
All Sexes
Eligible conditions
Select

Study Summary

External Drainage of Thoracic Duct Lymph to Reduce Inflammatory Cytokines in Septic Shock Patients

See full description

Eligible Conditions

  • Pyemia
  • Septic Shock

Treatment Effectiveness

Effectiveness Estimate

1 of 3

Compared to trials

Study Objectives

This trial is evaluating whether Thoracic duct drainage will improve 1 primary outcome in patients with Pyemia. Measurement will happen over the course of over 7 days of drainage.

Day 7
Reduction in circulating pro-inflammatory cytokines

Trial Safety

Safety Estimate

1 of 3

Compared to trials

Trial Design

1 Treatment Group

Thoracic Duct Drainage
1 of 1
Experimental Treatment

This trial requires 10 total participants across 1 different treatment group

This trial involves a single treatment. Thoracic Duct Drainage is the primary treatment being studied. Participants will all receive the same treatment. There is no placebo group. The treatments being tested are not being studied for commercial purposes.

Thoracic Duct Drainage
Procedure
This is the main study group of patients with thoracic duct drainage

Trial Logistics

Trial Timeline

Approximate Timeline
Screening: ~3 weeks
Treatment: Varies
Reporting: over 7 days of drainage
This trial has the following approximate timeline: 3 weeks for initial screening, variable treatment timelines, and roughly over 7 days of drainage for reporting.

Closest Location

University of Pennsylvania - Philadelphia, PA

Eligibility Criteria

This trial is for patients born any sex aged 18 and older. There are 4 eligibility criteria to participate in this trial as listed below.

Mark “yes” if the following statements are true for you:
Adult (18-80 years) patients in Surgical ICU with suspected or documented infection on antibiotics and septic shock defined as hypotension requiring vasopressor therapy to maintain MAP > 65mmHg (modified from Sepsis-35).
Participants will fulfill the inclusion criteria not only at recruitment and consent, but also be confirmed to still meet those criteria immediately prior to transfer to IR for the procedure.
The patient will not be recruited if he or she no longer meet these criteria.
Patients experiencing hemodynamic instability, defined as (1) MAPs < 65 despite ongoing up-titration of pressors and volume resuscitation or (2) active titration of vasopressors (more than 2 increases in past hour) or active volume resuscitation (more than 1-liter bolus in past hour) that precludes travel to IR during the intervention window will be excluded from the study and considered screen fails

Patient Q&A Section

Can shock be cured?

"[Electrocardiography parameters] measured during anesthesia show signs of increased sympathetic stimulation with no evidence of myocardial depression. [Cardiac output measurement] in [shock-induced]] patients [with] ventricular fibrillation is similar to [electrocardiography] measurements in [shock+animals.] The [mean arterial] and [systemic venous] pressure, [circulatory blood] volume, and [cardiac ejection] time in patients who [survived] during the [shock-induced]] ventricular [fibrillation] [were] similar to those observed in shock+animals." - Anonymous Online Contributor

Unverified Answer

What causes shock?

"Shock is best evaluated and managed in three phases: prehypotensive, hypovolemic, and refractory or persistent shock. In the first phase, the blood volume must be replaced if it is lost beyond replenishment of blood products. It is most appropriate to use blood in those who must arrive immediately in the emergency room or surgery for treatment. In the second phase, correcting hypovolemia is essential. To treat hypovolemia, fluids should be given. In the third phase, the aim is to define this disorder and to treat it as soon as possible." - Anonymous Online Contributor

Unverified Answer

What are common treatments for shock?

"For patients suffering from severe shock, no single treatment has been shown to improve outcomes more than another. The choice of intervention based upon the experience of the physician is recommended." - Anonymous Online Contributor

Unverified Answer

What is shock?

"Shock is a disease caused by insufficient blood flow to the heart, the brain, and parts of the body. This may occur during severe trauma, injury, or sepsis. The person may look strong and healthy until blood flow to major organs stops. Severe shock is an emergency and the main reason for hospital admission.\n" - Anonymous Online Contributor

Unverified Answer

What are the signs of shock?

"Symptoms of shock include rapid heartbeat, pale complexion, cold, dilated pupils, poor sucking of the lips, and low blood pressure. The signs of shock depend on the underlying cause.\n" - Anonymous Online Contributor

Unverified Answer

How many people get shock a year in the United States?

"About one in four Americans who receive medical care has a shock and/or critical illness. Half of those have a shock and/or ICU stay. Nearly 20 million people have shock and/or ICU stays in the United States annually, about the same number who die from cardiac conditions. Shock and critical illness are [approximately] $26 billion a year." - Anonymous Online Contributor

Unverified Answer

Does shock run in families?

"Inherited genetic risk is a substantial predictor of disease outcomes and can be detected in individuals without a familial history of the syndrome. Genetic markers can provide a targeted approach to unravel the complex interplay between genetics and the environment that leads to shock." - Anonymous Online Contributor

Unverified Answer

How serious can shock be?

"As reported in popular press it is easy to confuse shock for death; however, in spite of the seriousness of shock, most survivors will be able to recover adequately so long as they survive the initial shock response. The mortality due to shock is a result of the loss of life with uncontrolled resuscitation and severe trauma." - Anonymous Online Contributor

Unverified Answer

What does thoracic duct drainage usually treat?

"The majority of patients had successful treatment of symptoms but persistent abnormalities on the endoscopy. The incidence of chronic pancreatitis following drain placement in CP patients (8%) is significantly greater than that reported for any other type of pleural effusion (0-5%). Thus, the draining of CP patients and/or long-term follow-up is recommended." - Anonymous Online Contributor

Unverified Answer

What is thoracic duct drainage?

"We believe that it is the thoracic duct system that creates the blood pressure that is used as a guideline for the pressure to be applied to the chest of an anesthetized child prior to surgery. Once the blood pressure has been set there is no need to apply a pressure on the sternum with the aid of a ventilator. The use of the ventilator and pressure application on the sternum could even be banned until we do an additional study about it, as it could even cause more blood loss and hypovolemia due to the ventilator and pressure application. These new studies are necessary to understand how to minimize and even eliminate the risks associated with the thoracic duct and how to reduce the trauma involved." - Anonymous Online Contributor

Unverified Answer

Is thoracic duct drainage safe for people?

"Thoracic duct drainage as proposed by Macdonald is safe in the majority of people. The small risk of thromboembolism is insignificant. The risks of shock or injury are very low and a decision to drain the thoracic duct cannot be made on the basis of these risks. If pleural drainage is needed then the best way to do this is on an individual (within the expertise of the thoracic surgeon and/or radiologists) basis. In our experience this usually requires a small thoracotomy and drainage into the right side of the chest cavity. Drainage into the left side of the chest cavity carries a significant risk of pneumothorax." - Anonymous Online Contributor

Unverified Answer

What are the latest developments in thoracic duct drainage for therapeutic use?

"Thoracic duct drainage has been a major advancement to improve survival of patients with mediastinal/hilar lymphadenitis. Currently, it is used in some 20 percent of patients with mediastinal lymphadenitis. The current method for thoracic drainage is using a thoracotomy in the chest as the sole method of drainage with the use of an elastomeric drainage tube. Thoracotomy has been shown to have minimal complications, with its benefit being excellent and long-lasting drainage without the constant drain. The authors are hopeful that further advances in thoracic drainage will be made using the thoracoscopic approach." - Anonymous Online Contributor

Unverified Answer
Please Note: These questions and answers are submitted by anonymous patients, and have not been verified by our internal team.
See if you qualify for this trial
Get access to this novel treatment for Pyemia by sharing your contact details with the study coordinator.