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Chest drain REgular FLushing in ComplIcated parapneumonic EFfusions and empyemas: Study protocol for the RELIEF
Taryn K Boyle1, Jennifer D Duke1, Gulmira Yermakhanova1
1Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
Plos One
|March 5, 2026
Summary
This study investigates regular versus as-needed chest drain flushing for pleural infections. It aims to determine if routine flushing impacts chest tube removal time and patient outcomes.
Area of Science:
- Pulmonology
- Critical Care Medicine
- Infectious Diseases
Background:
- Pleural infections necessitate chest drain placement and antimicrobial therapy.
- Current guidelines recommend regular chest drain flushing, but evidence from randomized controlled trials (RCTs) is lacking.
- Inconsistent flushing practices complicate treatment evaluation and patient outcomes.
Purpose of the Study:
- To compare the impact of regular saline flushing versus as-needed flushing on chest drain removal time in patients with pleural space infections.
- To evaluate the effect of flushing protocols on hospitalization length, radiographic improvement, and complication rates.
Main Methods:
- The Chest Drain REgular FLushing in ComplIcated Parapneumonic EFfusions and Empyemas (RELIEF) trial is a multi-center, open-label RCT.
- Patients with pleural infection requiring chest drains are randomized to regular or as-needed flushing.
- Primary outcome: time to chest drain removal; secondary outcomes: hospitalization, radiographic improvement, and complications.
Main Results:
- This section is not yet available as the study is ongoing.
Conclusions:
- The RELIEF trial is the first RCT to evaluate chest drain flushing protocols using patient-centered outcomes for pleural space infections.
- Findings will clarify the role of regular flushing in managing complicated parapneumonic effusions and empyemas.
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