PURPOSE:Recurrent pleural effusions constitute a significant clinical problem. Thoracoscopic talc insufflation (TTI) has been used successfully to obliterate the pleural space and prevent fluid reaccumulation. Reports of acute pneumonitis and ARDS following the use of talc for pleurodesis have raised concerns about its safety. Two large prospective studies from Europe were recently published, and attest to the safety of talc poudrage. Differences in particle size of various talc preparations have been described and may explain the variable occurrence of pneumonitis. We sought to determine the incidence of respiratory failure following TTI over a 12-year period at our institution.
METHODS:Patients who underwent TTI for recurrent pleural effusions or spontaneous pneumothorax between January 1994 and July 2007 were identified from a prospectively maintained thoracoscopy logbook. The talc used during this period was commercially available sterile talc delivered using single-use pressurized spray canisters (Sclerosol®, Bryan Corporation, Woburn MA). Data extracted upon chart review included patient characteristics, pleural effusion etiology, and details of the procedure performed. The post-procedure hospital course was reviewed and all cases of respiratory failure were examined with regards to onset, etiology and outcome.
RESULTS:A total of 138 patients underwent 142 thoracoscopic talc insufflations for recurrent pleural effusions (139 procedures) or spontaneous pneumothorax (3 procedures) during this period. The mean age was 67 years (+/- 13 years). TTI was performed most frequently for malignant pleural effusions (76.3% of effusions). The median dose of talc insufflated was 6 g (range 2–8 g). Twelve patients developed dyspnea with increased O2 requirements within 24 to 72 hours of the procedure. Acute lung injury related to talc was felt to be responsible for the respiratory deterioration in 8 patients.
CONCLUSION:We report the occurrence of acute lung injury following TTI using the only FDA-approved talc in the United States.
CLINICAL IMPLICATIONS:These results contrast with those reported in two recent European prospective studies, and reinforce previous concerns regarding the talc used for pleurodesis in the United States.
DISCLOSURE:Anne Gonzalez, No Financial Disclosure Information; No Product/Research Disclosure Information