Effect of pleurodesis with negative pressure suction plus bleomycin on malignant pleural effusions; a clinical trial

Abstract

Introduction: About 50% of patients with metastatic cancers suffer from malignant pleural effusion. The goals of treatment for these patients should be to relieve pain, restore normal function, reduce or eliminate hospitalization, and make efficient use of medical care resources. Objectives: This study aimed to evaluate the effect of negative pressure suction on the success rate of pleurodesis with bleomycin on malignant pleural effusion. Patients and Methods: This study was conducted as before-after interventional study, without randomization. For all patients, 1 mg/kg bleomycin diluted with 50 mL distilled water, was injected into the chest tube. After changing the position of the patient, the clamp was opened and the tube was connected to the central suction with two chest bottles. The negative pressure suction was 20 cmH2O. Before intervention and four weeks after the intervention, a simple decubitus lateral chest X-ray was taken and the amount of malignant pleural effusion was assessed and compared with the amount of pleural effusion before the insertion of the chest tube. If the pleural effusion level was greater than 10 mm from the outer part of the chest, pleurodesis was considered unsuccessful Results: The mean age of patients was 60.44 ± 10.48 years (32-79 years); of which 12 patients (48%) were male. The most common cancer was lung cancer (48%). The success rate of treatment with bleomycin accompanied by negative pressure suction was 80% without a significant relationship with age, gender and type of cancer. Additionally, the results showed the improvement of the respiratory status and the pain level after the pleurodesis. The only side effect after bleomycin injection was fever in 84% of patients. Conclusion: Bleomycin treatment accompanied by negative pressure suction can improve malignant pleural effusion and this method is recommended for these patients.