Scientific Papers
Respiratory failure following talc pleurodesis

Presented at the 85th Annual Meeting of the North Pacific Surgical Association, Tacoma, Washington, November 13–14, 1998.
https://doi.org/10.1016/S0002-9610(99)00075-6Get rights and content

Abstract

Background: Sterile talc is currently the agent of choice for pleurodesis. Its success rate is excellent, and talc is generally well tolerated. However, a recent experience with fulminant pneumonitis following talc pleurodesis prompted a review of our experience.

Methods: A retrospective review of patients undergoing talc pleurodesis at our institution between December 1993 and December 1997 was performed, documenting respiratory and other complications. Statistical analysis was performed using Student’s t test and Pearson correlations

Results: Seventy-eight patients received 89 talc pleurodesis procedures. Respiratory complications or death occurred in 33%; 9% of patients developed adult respiratory distress syndrome. There was no statistical difference in outcomes between patient groups, methods of application, or talc dosages utilized.

Conclusions: This series revealed a significantly higher rate of serious complications than that reported in the current literature, without implicating a clear reason for these outcomes. Our data raise questions about the safety of talc pleurodesis.

Section snippets

Materials and methods

Seventy-eight patients with recurrent pleural effusions or pneumothorax were treated via pleurodesis between December 1993 and December 1997 at a single institution. Five patients had bilateral pleural effusions, resulting in a total of 89 procedures over this study period. Patient demographics are reported in Table I. Each patient record was examined for documentation of complications. The Investigational Review Board approved the chart review.

Talc was administered via poudrage in 19

Results

Of the patients presenting with malignant effusions, 18 presented with a primary carcinoma from the lung, 12 from the ovary, 10 from the breast, and 6 from lymphoma; 13 patients had less common primaries. Nine patients had benign or undiagnosed effusions, and 9 had spontaneous pneumothoraces. Table I contrasts the data between groups of patients with and without complications following pleurodesis.

Of the procedures evaluated, 19 (21%) involved only minor complications including: fever >100.5°F

Comments

Talc is a tri-layered magnesium sheet with lubricant properties; it is rarely found as a pure entity in nature. The mechanism of action in pleurodesis has not been fully elucidated, although talc is thought to stimulate a typical local inflammatory response, with decreased fibrinolytic activity, mesothelial cell injury, and fibroblast proliferation. The pathologic condition of pneumonitis or respiratory failure may be secondary to downstream inflammatory mediators from more proximal talc injury.

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