open access

Vol 13, No 2 (2019)
Research paper
Published online: 2019-06-05
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Limb edema in patients with advanced disease — a pilot study of compression therapy combined with diuretics

Tomasz Grądalski
DOI: 10.5603/PMPI.2019.0009
·
Palliat Med Pract 2019;13(2):51-56.

open access

Vol 13, No 2 (2019)
Original articles
Published online: 2019-06-05

Abstract

Introduction. Management of edema due to advanced disease is seldom recognized in palliative care. The
purpose of this pilot study was to assess the effectiveness and tolerance of conservative edema therapy.
Material and methods. Prospective analysis of limb volumes, edema symptom burden and quality of life
(QoL) in 119 patients diagnosed with edema was performed. Eighteen patients in their last days of life
complaining of edema were treated by limb elevation, supportive (palliative) bandaging, manual lymphatic
drainage, Kinesio Taping and/or controlled subcutaneous needle drainage. Forty-six with longer prognosis
were treated by one-week multilayer short-stretch limb bandaging and then re-evaluated. Twenty-eight
of them with venous congestion resistant to previously given diuretics received additionally furosemide
infusion in hypertonic saline. Subgroups analysis of the patients with diuretic therapy and primary lymphatic
congestion was performed.
Results. Within 46 patients re-evaluated the reduction of limb volume was accompanied by a decrease
of edema symptom intensity and an improvement of QoL. Subgroup analysis revealed both volume and
symptomatic improvement, equally effective in cases with suspected lymphatic congestion or when diuretics
were added.
Conclusion. Edema of advanced disease irrespective of the lymphatic component can be effectively
managed conservatively with short–stretch limb bandaging. In cases resistant to oral diuretic fluid overload,
parenteral hypersaline furosemide addition to the compression may be the safe therapeutic option
enhancing treatment tolerance.

Abstract

Introduction. Management of edema due to advanced disease is seldom recognized in palliative care. The
purpose of this pilot study was to assess the effectiveness and tolerance of conservative edema therapy.
Material and methods. Prospective analysis of limb volumes, edema symptom burden and quality of life
(QoL) in 119 patients diagnosed with edema was performed. Eighteen patients in their last days of life
complaining of edema were treated by limb elevation, supportive (palliative) bandaging, manual lymphatic
drainage, Kinesio Taping and/or controlled subcutaneous needle drainage. Forty-six with longer prognosis
were treated by one-week multilayer short-stretch limb bandaging and then re-evaluated. Twenty-eight
of them with venous congestion resistant to previously given diuretics received additionally furosemide
infusion in hypertonic saline. Subgroups analysis of the patients with diuretic therapy and primary lymphatic
congestion was performed.
Results. Within 46 patients re-evaluated the reduction of limb volume was accompanied by a decrease
of edema symptom intensity and an improvement of QoL. Subgroup analysis revealed both volume and
symptomatic improvement, equally effective in cases with suspected lymphatic congestion or when diuretics
were added.
Conclusion. Edema of advanced disease irrespective of the lymphatic component can be effectively
managed conservatively with short–stretch limb bandaging. In cases resistant to oral diuretic fluid overload,
parenteral hypersaline furosemide addition to the compression may be the safe therapeutic option
enhancing treatment tolerance.

Get Citation

Keywords

advanced disease, diuretics, edema, furosemide, palliative care, quality of life

About this article
Title

Limb edema in patients with advanced disease — a pilot study of compression therapy combined with diuretics

Journal

Palliative Medicine in Practice

Issue

Vol 13, No 2 (2019)

Article type

Research paper

Pages

51-56

Published online

2019-06-05

DOI

10.5603/PMPI.2019.0009

Bibliographic record

Palliat Med Pract 2019;13(2):51-56.

Keywords

advanced disease
diuretics
edema
furosemide
palliative care
quality of life

Authors

Tomasz Grądalski

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