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Thoracoscopic Talc Poudrage in Malignant Pleural Effusions : Effective Pleurodesis Despite Low Pleural pH

Yossef Aelony; Randal Robert King; Christian Boutin
Author and Funding Information

Affiliations: From the Department of Medicine, Kaiser-Permanente, Harbor City, Calif,  From the Pulmonary Department, Hopital de la Conception, Marseilles, France

Affiliations: From the Department of Medicine, Kaiser-Permanente, Harbor City, Calif,  From the Pulmonary Department, Hopital de la Conception, Marseilles, France


1998 by the American College of Chest Physicians


Chest. 1998;113(4):1007-1012. doi:10.1378/chest.113.4.1007
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Abstract

Study objective: To determine the effectiveness of pleurodesis by thoracoscopic talc poudrage (TTP) in patients with low pH malignant pleural effusions.

Design: Review of prospectively collected data on all thoracoscopic procedures performed from 1982 to 1996.

Patients and setting: Twenty-five members in a prepaid, closed-panel health maintenance organization, whose malignant pleural effusion pH was ≤7.30.

Interventions: Pleural fluid pH was measured prior to diagnostic and therapeutic, single puncture, rigid thoracoscopy, under local anesthesia, in an operating room.

Measurements and results: Success of pleurodesis was determined with serial radiographs at 10 days, 30 days, and frequent intervals until death or up to 1 year following the procedure. Failure was indicated by evidence of recurrent fluid or persistence of a space between the visceral and parietal pleura. Morbidity of the procedure, days of chest tube drainage, and days of hospitalization were recorded concurrently during hospitalization and outpatient follow-up. Fifty of the 76 patients found to have a pleural pH measurement had a pleural pH >7.30, averaging 7.37 (7.31 to 7.55). The other 26 patients (34%) with pH ≤7.30 (low pH) are the subjects of this study, of whom 25 were evaluable. Pleurodesis was successful in 22 of 25 (88%), although 4 died prior to 30 days. The three failures all had trapped lung. Chest tube drainage averaged 3.2±1.3 days, which approximated the time of hospitalization (3.3±1.1 days). There were no thoracoscopy-related deaths; significant morbidity occurred only in one patient with trapped lung, who had prolonged chest tube drainage before and after TTP, and eventually developed empyema.

Conclusions: TTP is an effective pleurodesis technique in malignant pleural effusions, even when the pleural pH is low. The short hospital stay and high success rate make this approach a good choice in palliating symptomatic malignant pleural effusions.


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