Comparison of early Pleurodesis Practice with conventional (Late) Pleurodesis Practice in patients with Radiologically Expanded Lung having Exudative Pleural Effusion
Keywords:Malignant Pleural effusion, Early pleurodesis, late pleurodesis
AbstractIntroduction:Malignant pleural effusion is commonest cause of exudativepleural effusions. Chemical pleurodesis, using an intrapleural sclerosingagent, is a good palliative measure to obliterate the pleural space, prevent fluidaccumulation and improve breathing.Objective: To compare early pleurodesis practice with late pleurodesis practice in with patients with radiologically expanded lung in term of pleurodesis success, post pleurodesis drainage, and hospital stay.Study Design, Place and Duration: It was a randomized clinical trial conducted in Pulmonology Department, Post Graduate Medical Institute, Lady Reading Hospital, Peshawar, from26 March 2009 to 25 March 2010.Materials and Methods: Patients with malignant pleural effusion were randomly assigned to early pleurodesis group (Group I) and late pleurodesis group (Group II). Tetracycline was used as sclerosing agent for pleurodesis in both groups. Group I comprises those patients in whom lung was expanded radiologically while daily drainage was still more than 100ml. Group II includes those patients in whom lung was expanded as well as daily drainage was less 100ml. pleurodesis was considered successful if post pleurodesis drainage was less than 150ml in 24 hours and failed if drainage was more than 150 ml per day for 3 days. Total hospitay stay was counted from the date of intubation to the date of extubation.Results: Out of 234 patients 122 (51.1%) were males and 112 (47.9%) were females. In Group I age range was 17 to 110 years with mean of 58 + 15 SD, while in Group II, age range was 13 to 90 years with mean of 54+14 SD. In Group I and Group II the pleurodesis success rate was 89.3% and 94% respectively (p 0.260). Mean post pleurodesis drainage in successful Group I and Group II was 164 ml 341 and 99+138 (P-value 0.95). Mean hospital stay in Group I was 6.16 days 5 while In Group II mean hospital stay was 7.88 days 4 with a Pvalue of 0.017.( Mean hospital stay in successful Group I was 5.19 days 3.5 while In Group II mean hospital stay was 7.6 days 4.15 with a p value of 0.000). Comparison of the early versus late pleurodesis in term of hospital stay showed significant difference (P-value <0.05).Conclusion: Early pleurodesis is not inferior and as better as late pleurodesis in patients with pleural effusion when lung is expanded radiologically irrespective of the excessive daily drainage.