Taryn K. Boyle; Jennifer D. Duke; Gulmira Yermakhanova; Rafael Paez; Greta Bridwell; Ankush P. Ratwani; Kaele M. Leonard; Heidi Chen; Frank E. Harrell Jr.; Robert J. Lentz; Fabien Maldonado; Najib M. Rahman; Samira Shojaee (2026).听.听PLOS ONE, 21(3), e0331725.听
This article describes a clinical trial designed to determine the best way to manage chest drains in patients with听pleural infections, which are infections in the space around the lungs. These infections are often treated by inserting a small tube (a chest drain) to remove infected fluid, along with antibiotics. Current guidelines recommend regularly flushing these tubes with saline (saltwater) to keep them from clogging, but this practice has not been tested in a rigorous randomized controlled trial, and approaches vary widely in real-world care.
To address this, researchers designed the RELIEF trial, a multi-center study in the United States. Patients with pleural infections who need a chest drain will be randomly assigned to one of two groups: one receiving听regular flushing听(every six hours) and the other receiving flushing only听as needed听if the tube becomes blocked. The main outcome being measured is how long it takes before the chest tube can be safely removed. Additional outcomes include length of hospital stay, improvement seen on imaging scans (such as X-rays or CT scans), the need for further procedures, and any complications. The researchers will also use advanced statistical modeling to track how patients progress over time in each group.
Overall, this study aims to provide clear evidence on whether routine flushing of chest drains improves patient outcomes, helping to standardize care and potentially improve treatment for pleural infections.
Fig 1.听Schematic of study design.
Abbreviations: CPPE: Complicated parapneumonic effusion, IET: Intrapleural enzyme therapy (tPA/DNase), NS: Normal saline, CXR: Chest X-ray, US: Ultrasound, CT scan: Computed Tomography scan. *Chest drain blockage is assessed by lack of tidaling, lack of fluid drainage, and presence of pleural fluid on US exam.
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