Disorders of the Pleura |

A Comparative Study on the Success Rate and Complications of Low Dose vs High Dose Talc Pleurodesis in Malignant Pleural Effusion FREE TO VIEW

Ravi Jha, MBBS
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Max Superspeciality Hospital, Saket, Delhi, India

Chest. 2014;146(4_MeetingAbstracts):428A. doi:10.1378/chest.1965646
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SESSION TITLE: Malignant Pleural Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Role of talc in pleurodesis for recurrent pleural effusion is very well known. In developing countries like India, talc is still the cheaper and commonly used pleurodesis agent. Talc is also one of the best agent for pleurodesis. However, it has been known to be associated with a lot of post procedure morbidity including ARDS. Common morbidities include fever, chest pain, nausea and vomiting. Many authors and clinicians beleive that increasing the dose of talc used can increase the success rate of pleurodesis. The aim of this study was to see the effectiveness of low dose talc pleurodesis, and to evaluate if low dose talc is associated with lesser complications.

METHODS: 46 adult patients of malignant pleural effusion were included in the study. Patients were divided in two groups. In group A (n=18), 5 gm of talc was used while in group B (n=28), pleurodesis was done with 10 gm of talc. Equal amount of xylocaine and normal saline was used in both the groups. Standard method for pleurodesis was followed. Close observation was done for next 48 hours, and after that patients were followed every week till 6 weeks.

RESULTS: Immediate complication in terms of fever, chest pain and nausea was seen in 39% (n=7) patients of group A where 5 gm of talc was used. When these patients were followed up for next 6 weeks, 44% (n=8) of patients showed recurrence of effusion, and required repeated thoracocentesis. In group B, 43% (n=12) patients developed immediate complications in terms of high grade fever, and vomiting. In group B, 39% (n=11) patients showed recurrence of pleural effusion and required repeated thoracocentesis. The difference between the outcome in terms of recurrence of pleural effusion or immediate morbidity was statistically not significant between the two groups (p>0.05). ARDS was not seen in either group.

CONCLUSIONS: Talc pleurodesis with lower dose of 5 gm is associated with almost similar percentage of complications and is equally effective as with 10 gm of talc.

CLINICAL IMPLICATIONS: Low dose talc is as effective as high dose when pleurodesis is done by conventional method. When video assisted thoracoscopy is not available, low dose talc (5 gm) should always be used for pleurodesis in malignant pleural effusion.

DISCLOSURE: The following authors have nothing to disclose: Ravi Jha

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