Study Designed to Optimize the Treatment of Primary Pneumothorax

NCT ID: NCT02866305

Last Updated: 2016-08-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

EARLY_PHASE1

Total Enrollment

300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-03-31

Study Completion Date

2024-12-31

Brief Summary

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Knowledge about incidence, risk factors and genetic predispositions of primary spontaneous pneumothorax in young adults is very limited, and treatment has also been controversial.The Aim of this study is to optimize the treatment, estimate the actual incidence, and identify possible risk factors including genetic predispositions.

Detailed Description

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* Background Knowledge about incidence, risk factors and genetic predispositions of primary spontaneous pneumothorax in young adults is very limited, and treatment has also been controversial. Typically, the first incidence is treated conservatively with simple chest tube drainage and only if the disease reoccurs is surgery considered. However, conventional treatment may be associated with increased morbidity, prolonged hospitalization and many young adults are concerned about the high recurrence of this disease. The latter has been reported in as many as 25-35% of patients. Because spontaneous pneumothorax in young adults usually is associated with apical blebs, the investigators hypothesized that primary surgery (Video-Assisted Thoracoscopic Surgery = VATS) with resection of such blebs at the time of the first episode of pneumothorax might be an effective first line treatment associated with lower morbidity and shorter hospital stays, and a definite decline in recurrence rate.
* Method From July 2009 the investigators conducted a nationwide study , where 300 consecutive patients admitted to a Danish hospital with primary spontaneous pneumothorax undergo a high resolution CT of the thorax. Based upon the CT the patients are randomised to conventional conservative treatment (chest tube drainage) or primary VATS with bleb resection and mechanical pleurodesis.

Participants are followed for ten years. The primary endpoint is ipsilateral recurrence of pneumothorax. Secondary endpoints are length of hospitalization, duration of chest tube drainage and miscellaneous complications.

Simultaneously, a research biobank containing blood samples and pulmonary tissue is created for future studies of biomarkers and possible genetic causes.

Finally, the investigators are conducting a national epidemiological study, where the incidence in the Danish population is investigated.

\*Perspective This study contributes new knowledge on incidence, genetics and best treatment of primary spontaneous pneumothorax in young adults which will have an impact on the future strategy of both understanding and treatment of this disease on a global level.

Conditions

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Primary Spontaneous Pneumothorax Pleural Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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HRCT with bullae, treatment conservative

Patients undergo High-resolution CT scan, and significant bullae are identified (i.e. \> 1 cm). Afterwards randomised to conservative treatment with conventional chest-tube drainage.

Group Type EXPERIMENTAL

Chest tube insertion

Intervention Type PROCEDURE

Conventional chest tube insertion.

High-resolution Computer Tomography

Intervention Type RADIATION

All participants included in this study had a HRCT performed.

HRCT no bullae, treatment conservative

Patients undergo High-resolution CT scan, and no significant bullae are identified (i.e. \> 1 cm). Afterwards randomised to conservative treatment with conventional chest-tube drainage.

Group Type EXPERIMENTAL

Chest tube insertion

Intervention Type PROCEDURE

Conventional chest tube insertion.

High-resolution Computer Tomography

Intervention Type RADIATION

All participants included in this study had a HRCT performed.

HRCT with bullae, treatment VATS.

Patients undergo High-resolution CT scan, and significant bullae are identified (i.e. \> 1 cm). Afterwards randomised to active treatment with VATS bullectomy and mechanical pleurodesis.

Group Type EXPERIMENTAL

VATS bullectomy and mechanical pleuradesis.

Intervention Type PROCEDURE

Thoracoscopic bullectomy is performed on all visible bullae, alternatively is no visible bullae, the apex is resected. Then mechanical pleuradesis is performed.

Chest tube insertion

Intervention Type PROCEDURE

Conventional chest tube insertion.

Epidural

Intervention Type DRUG

All surgical participants received an epidural prior to the procedure.The epidural was removed simultaneous with the the chest tube.

High-resolution Computer Tomography

Intervention Type RADIATION

All participants included in this study had a HRCT performed.

HRCT no bullae, treatment VATS.

Patients undergo High-resolution CT scan, and no significant bullae are identified (i.e. \> 1 cm). Afterwards randomised to active treatment with VATS bullectomy and mechanical pleurodesis.

Group Type EXPERIMENTAL

VATS bullectomy and mechanical pleuradesis.

Intervention Type PROCEDURE

Thoracoscopic bullectomy is performed on all visible bullae, alternatively is no visible bullae, the apex is resected. Then mechanical pleuradesis is performed.

Chest tube insertion

Intervention Type PROCEDURE

Conventional chest tube insertion.

Epidural

Intervention Type DRUG

All surgical participants received an epidural prior to the procedure.The epidural was removed simultaneous with the the chest tube.

High-resolution Computer Tomography

Intervention Type RADIATION

All participants included in this study had a HRCT performed.

Interventions

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VATS bullectomy and mechanical pleuradesis.

Thoracoscopic bullectomy is performed on all visible bullae, alternatively is no visible bullae, the apex is resected. Then mechanical pleuradesis is performed.

Intervention Type PROCEDURE

Chest tube insertion

Conventional chest tube insertion.

Intervention Type PROCEDURE

Epidural

All surgical participants received an epidural prior to the procedure.The epidural was removed simultaneous with the the chest tube.

Intervention Type DRUG

High-resolution Computer Tomography

All participants included in this study had a HRCT performed.

Intervention Type RADIATION

Other Intervention Names

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Pain- catheter

Eligibility Criteria

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Inclusion Criteria

* First incidence of primary spontaneous pneumothorax.
* Age between 18 and 40.
* No known preexisting pulmonary disease.
* Patient must accept randomization.
* Able to read and understand information regarding the study.
* The condition must require treatment with a chest-tube.

Exclusion Criteria

* Age above 40.
* Previously pulmonary og cardiac surgery.
* Pregnant or breastfeeding.
* Patients who do not tolerate anesthetics.
Minimum Eligible Age

18 Years

Maximum Eligible Age

40 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Danish Medical Association

OTHER

Sponsor Role collaborator

Danmarks Lungeforening

OTHER

Sponsor Role collaborator

Odense University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Winnie Hedevang Olesen

MD and Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Winnie Hedevang Olesen, ph.d.student

Role: STUDY_DIRECTOR

Research Unit at the Cardiothoracic Department at the University Hospital of Odense.

Peter Bjørn Licht, Professor MD

Role: PRINCIPAL_INVESTIGATOR

Research Unit at the Cardiothoracic Department at the University Hospital of Odense

Locations

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Research Unit at the Cardiothoracic Department at the University Hospital of Skejby

Aarhus, Central Jutland, Denmark

Site Status RECRUITING

Research Unit at the cardiothoracic departement at the University Hospital of Odense

Odense, Fyn, Denmark

Site Status RECRUITING

Research Unit at the Cardiothoracic Department af Ålborg Hospital

Aalborg, North Denmark, Denmark

Site Status RECRUITING

Countries

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Denmark

Central Contacts

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Winnie Hedevang Olesen, ph.d.student

Role: CONTACT

0045-22947131

Peter Bjørn Licht, Professor

Role: CONTACT

0045-65413385

Facility Contacts

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Winnie Hedevang Olesen, ph.d.student

Role: primary

0045-22947131

Peter Bjørn Licht, Professor

Role: backup

0045-65413385

References

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Olesen WH, Katballe N, Sindby JE, Titlestad IL, Andersen PE, Lindahl-Jacobsen R, Licht PB. Surgical treatment versus conventional chest tube drainage in primary spontaneous pneumothorax: a randomized controlled trial. Eur J Cardiothorac Surg. 2018 Jul 1;54(1):113-121. doi: 10.1093/ejcts/ezy003.

Reference Type DERIVED
PMID: 29509892 (View on PubMed)

Other Identifiers

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TOPP2009

Identifier Type: -

Identifier Source: org_study_id

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