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Limb edema in patients with advanced disease — a pilot study of compression therapy combined with diuretics
Affiliations- St Lazarus Hospice, Poland
open access
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.
Keywords
advanced disease, diuretics, edema, furosemide, palliative care, quality of life
About this articleTitle
Limb edema in patients with advanced disease — a pilot study of compression therapy combined with diuretics
Journal
Palliative Medicine in Practice
Issue
Article type
Research paper
Pages
51-56
Published online
2019-06-05
Page views
1562
Article views/downloads
1056
DOI
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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