To evaluate safety and efficacy of silver nitrate (SN) pleurodesis in malignant pleural effusion (MPE) patients performed in an outpatient setting.
Prospective study including consecutive patients with recurrent and symptomatic MPE (January/08 until January/09). All patients underwent pleural catheter implantation followed by instillation of 30 mL of 0.5% SN in our outpatient clinic. The primary outcome was efficacy and the procedure was considered successful if no additional pleural procedure was required. Secondary outcomes were safety and quality of life, the first evaluated according to adverse events monitoring and the former through the WHO-Bref questionnaire.
During the study period 57 patients (44 female/13 male), average age 56.9±13 years with MPE due to: breast cancer (35), lymphoma (7), lung (6) and other (8) were enrolled. They underwent 62 pleural catheters placements (5 bilateral). One patient had a malpositioned catheter which had to be switched for a new one, no other complication was observed. After a mean time of 5.8±5.0 days, 57 pleurodesis were performed (3 patients had a trapped lung and 2 had disease progression and eventually died). Total drainage time was 11.7±6.5 days. Complications after pleurodesis were: moderate/severe pain in 6 patients (graded as 6 or higher in visual analog scale), catheter obstruction in 4, and fever, subcutaneous emphysema and wound infection in one patient each. One patient had to be admitted to the hospital for 6 ours for pain control. Two patients had pleurodesis failure and new pleural procedures were required (thoracentesis). 30th-day quality of life scores improved but only physical aspects dominium showed statistical significance (p=0.003). Six patients have died within 30 days after pleurodesis due to disease progression and mean follow-up time was 4.3±3.9 months.
SN pleurodesis may be performed safely and comfortably in an outpatient setting. In this study we observed good efficacy and low complication rate after such procedure.
Silver nitrate pleurodesis seems to be an option for outpatient care of patients with symptomatic and recurrent MPE.
Ricardo Terra, No Financial Disclosure Information; No Product/Research Disclosure Information