Pleurodesis Using Talc Slurry

doi:10.1378/chest.106.2.342

Chest

Volume 106, Issue 2, August 1994, Pages 342-346

https://doi.org/10.1378/chest.106.2.342 Get rights and content

Objective: To determine the efficacy and safety of talc slurry for pleurodesis.

Design: Retrospective.

Participants: All patients who received talc slurry via tube thoracostomy at Memorial Sloan-Kettering Cancer Center from March 1991 to April 1992.

Results: Fifty-eight patients received talc slurry in 75 procedures; five patients had 2 unilateral procedures and 12 had bilateral procedures. Fifty-two patients had malignant pleural effusions with the most common cell types being breast (23 of 52, 44 percent), lung (4 of 52, 8 percent), ovarian (4 of 52, 8 percent), and endometrial (3 of 52, 6 percent). Four patients had benign conditions. The mean duration of follow-up was 171 days (range, 2 to 450 days). Success, defined as the absence of pleural fluid reaccumulation, was evaluable in 47 of 73 (64 percent) procedures. Pleurodesis was successful in 38 of 47 (81 percent). Adverse effects associated with pleurodesis included fever (46 of 73, 63 percent), empyema (4 of 73, 5 percent), atrial arrhythmia (3 of 73, 4 percent), hypotension (3 of 73, 4 percent), and hypoxemic respiratory failure (3 of 73, 4 percent). There were no deaths attributable to the procedure.

Conclusions: Talc slurry instilled through a chest tube is an effective bedside method of pleurodesis. Fever occurs frequently. Respiratory failure is a rare but potentially serious complication that deserves further investigation.

Section snippets

Patients and Materials

Patient charts and chest radiographs of all patients who received talc slurry via tube thoracostomy from March 1991 to April 1992 at Memorial Sloan-Kettering Cancer Center were identified for review. There were 75 procedures in 58 patients; two charts (two procedures) were unavailable leaving 73 procedures in 56 patients for review. Patient characteristics, chest tube duration, chest tube drainage, and complications were obtained from physician and nursing progress notes.

Chest radiographs were

Results

Forty of 56 patients were women, accounting for 56 of the 73 procedures. The mean (SEM) age was 54.4 ± 2.0 years (range, 32 to 84 years). Thirty-five procedures were performed on the right hemithorax and 38 were performed on the left. Five patients had two unilateral procedures; 12 patients had sequential, bilateral procedures. Sixty-nine procedures were performed for malignant or paramalignant pleural effusions. Three procedures were performed for closure of persistent bronchopleural fistulas

Discussion

Talc is a naturally occurring magnesium sheet silicate (Mg₃Si₄O₁₀[OH]₂) that is mined in many parts of the world. Talc ores are frequently associated with other minerals and impurities are common, the most notable of which is asbestos. Many grades and particle sizes of talc are commercially available. Talc that is used intrapleurally has traditionally been a USP asbestos-free product, the preparation of which has not been standardized. Investigation is currently underway to determine if

Acknowledgments

We would like to thank Drs. M. Bains, M. Burt, and P. McCormack of the Memorial Sloan-Kettering Cancer Center Thoracic Service for the inclusion of their patients in this study. We would also like to recognize the efforts of Jane Nolte, Pharm D (Memorial Sloan-Kettering Cancer Center) who developed the protocol for talc sterilization and packaging.

References (32)

BethuneN.
Pleural poudrage: a new technic for the deliberate production of pleural adhesions as a preliminary to lobectomy
J Thorac Surg
(1935)
HanrahanEM et al.
The role of experimentally produced intrapleural adhesions in extrapleural pneumonolysis and in the prevention of surgical atelectasis in animals
Thorac Surg
(1941)
SingerJJ et al.
Aseptic pleuritis experimentally produced
J Thorac Surg
(1941)
FentimanIS et al.
A comparison of intracavitary talc and tetracycline for the control of pleural effusions secondary to breast cancer
Eur J Cancer Clin Oncol
(1986)
WebbWR et al.
Iodized talc pleurodesis for the treatment of pleural effusions
J Thorac Cardiovasc Surg
(1992)
RinaldoJE et al.
Adult respiratory distress syndrome following intrapleural instillation of talc
J Thorac Cardiovasc Surg
(1983)
BouchamaA. et al.
Acute pneumonitis with bilateral pleural effusion after talc pleurodesis
Chest
(1984)
NandiP.
Recurrent spontaneous pneumothorax; an effective method of talc poudrage
Chest
(1980)
OhriSK et al.
Early and late outcome after diagnostic thoracoscopy and talc pleurodesis
Ann Thorac Surg
(1992)
WeissbergD. et al.
Diagnostic and therapeutic pleuro-scopy: experience with 127 patients
Chest
(1980)

AdlerRH.

A talc powder aerosol method for the prevention of recurrent spontaneous pneumothorax

Ann Thorac Surg

(1968)

HarleyHRS.

Malignant pleural effusions and their treatment by intercostal talc pleurodesis

Br J Dis Chest

(1979)

MillerKS et al.

Chest tubes: indications, technique, management and complications

Chest

(1987)

AdlerRH et al.

Treatment of malignant pleural effusion: a method using tube thoracostomy and talc

Ann Thorac Surg

(1976)

TomashefskiJF et al.

The pulmonary vascular lesions of intravenous drug abuse

Hum Pathol

(1980)

TrapnellDH et al.

Unilateral pulmonary oedema after pleural aspiration

Lancet

(1970)

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: Revision accepted November 29

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Clinical Investigations: The PleuraPleurodesis Using Talc Slurry

Section snippets

Patients and Materials

Results

Discussion

Acknowledgments

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Clinical Investigations: The Pleura
Pleurodesis Using Talc Slurry