title: Is silver nitrate pleurodesis for patients with malignant pleural effusion feasible and safe when performed in an outpatient setting?
abstract: BACKGROUND
  The purpose of this study was to analyze the effectiveness and safety of silver nitrate pleurodesis (SNP) in patients with recurrent malignant pleural effusion (RMPE) when performed in an outpatient setting.
  
  
  METHODS
  Prospective study including patients with RMPE recruited in a tertiary university-based hospital from February 2008 to June 2009. Elected patients underwent pleural catheter insertion (Day 1) followed by 0.5% SNP (Day 2), and on 7th day the drain was removed. All procedures were performed in an outpatient facility. Pleurodesis was considered successful when no additional pleural procedure was necessary by the 30th day. Complications were registered and graded according to the CTCAE3.0. Quality of life was evaluated before and 30 days after SNP.
  
  
  RESULTS
  A total of 68 patients (54 female, 14 male, mean age: 57.3 years) were included. In addition, 7 had bilateral pleural effusions; therefore, 75 hemithoraces were drained. Also, 5 were excluded, and 70 hemithoraces (63 patients) underwent SNP. During the period of 30 days postpleurodesis, 8 deaths not related to the procedure occurred, and we lost contact with 10 patients who were followed elsewhere. At the 30th day, 48 hemithoraces (45 patients) were reevaluated, and 2 recurrences observed. The most frequent complication was pain--graded as 3 or more in 7 patients; infection occurred in 2 patients. Physical and environmental aspects of quality of life improved significantly after pleurodesis.
  
  
  CONCLUSIONS
  In this study, SNP could be performed safely in an outpatient setting, with pain the most frequent complication. Recurrences occurred in 4% of the patients.
authors.affiliation: Thoracic Surgery Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. rmterra@uol.com.br
authors.forename: Ricardo Mingarini
authors.initials: RM
authors.lastname: Terra
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Paulo Manuel
authors.initials: PM
authors.lastname: Pego-Fernandes
authors.forename: Lisete Ribeiro
authors.initials: LR
authors.lastname: Teixeira
authors.forename: Francisco Suso
authors.initials: FS
authors.lastname: Vargas
authors.forename: Fabio Biscegli
authors.initials: FB
authors.lastname: Jatene
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D018700:Pleurodesis; D011446:Prospective Studies; D012008:Recurrence; D012835:Silver Nitrate / Q000008:administration & dosage*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D012835:Silver Nitrate