Pleurodesis: a comparison of two sclerosing agents for pleural effusions in Mozambique

Background: Pleural effusionsconstitute one of the most frequent pathologies encountered in the pulmonary service of Maputo Central Hospital (MCH) in Mozambique. Bleomycinand talcare commonly used for pleurodesis, but cost prohibitive, therefore we aimed to retrospectively compare the efficacy and safety of sodium hydroxide (NaOH) with bleomycinfor pleurodesis. Methods: Case records of pleurodesisusing bleomycinand NaOH from 2002 to 2013 were reviewed. Standard of care for pleurodesisfor recurrent pleural effusionsat MCH was developed using the materials available. NaOH remained the agent of choice until 2006 when bleomycinbecame available. Clinical data regarding general complications, rate of success and lung expansion were noted for every patient who underwent pleurodesisat MCH during this time frame. Results: Review of pleurodesisat MCH revealed 24 cases using bleomycinand 23 cases using NaOH as the sclerosing agent. Patient characteristics were balanced between the two groups with majority of pleural effusionsmalignant in etiology. Conclusions: There was no statistically significant difference between the use of bleomycinand NaOH as defined by lung expansion. General complications were observed less frequently in 2 (10%) of patients treated with NaOH compared with 8 (38%) of patients using bleomycin. Only three patients presented with recurrent pleural effusionafter pleurodesiswith NaOH. NaOH may offer a low cost alternative sclerosing agent for resource limited areas.