A Randomized Controlled Study Evaluating the Efficacy and Safety of Silver Nitrates Injection Through Chest Tube Thoracostomy Versus Thoracoscopic Talc Insufflation for Pleurodesis in Cases of Malignant Pleural Effusion

Abstract Background: Malignant pleural effusions are one of the leading causes of recurrent pleural effusions worldwide causes substantial morbidity, which lead to affection of the quality of life. The principal goal in treating malignant pleural effusions is to improve respiratory status which lead to improvement in the quality of life, Pleurodesis is accepted to provide effective control of recurrent malignant pleural effusion. but, there is no existing consensus on the best way to achieve pleurodesis. Aim of Study: To compare the efficacy and the safety of Silver Nitrates given via thoracostomy tube versus thoraco-scopic insufflation of Talc, in the treatment of symptomatic malignant pleural effusion. Subjects and Methods: This study included 40 patients with malignant pleural effusion presented to Chest Departments of Al-Azhar University Hospitals (Al Hussine and Bab Al Shearea) from March 2016 to September 2017. They were randomisedly classified into two groups: - Group (I) where pleurodesis was done using 0.5% Silver Nitrates through chest tube thoracostomy. - Group (II) where pleurodesis was done through thoracoscopic insufflation using 5g sterilized asbestos free talc. Results: The outcome was 19 patients (95%) for group (I) responsive after a month of follow-up with one patient (5%) failed (unresponsive) during this period, and 18 patients (90%) for group (II) responsive with 2 patients (10%), failed (unresponsive) during the same period as regard pleurodesis related complications, The most common was chest pain, was recorded in all patients from group (I), and group (II). The second prevalent complication was fever; it was reported in 4 patients (20%) from group (I) and 7 patients (35%) from group (II). Only one patient (5%) from group (II) developed transient hypoxemia during thoracoscopic pleurodesis. Conclusion: SN was an effective agent for producing a pleurodesis. Because of easy instillation through Chest Tube Thoracostomy. It appears to be at least as effective as talc. The side effects of intrapleural SN at aconentration of 0.5% appear to be minimal and were comparable to those with talc, no evidence that the intrapleural injection of SN produces ARDS, it should be considered tobe a viable alternative to talc and other sclerosing agents for production of apleurodesis.