Chest
ORIGINAL RESEARCHPLEURAL DISEASELung Injury Following Thoracoscopic Talc Insufflation: Experience of a Single North American Center
Section snippets
Materials and Methods
The technique of medical thoracoscopy has been reviewed elsewhere.13, 14 Briefly, after patient positioning, preparation, and draping, lidocaine is instilled at the chosen point of entry (fourth to sixth intercostal space, midaxillary line). After blunt dissection, a trocar is inserted and pleural fluid evacuated using a suction catheter. Air is allowed to enter the pleural space to create a working space while equilibrating pleural pressures. The pleural space is inspected, and parietal
Results
A total of 138 patients underwent 142 procedures between January 1994 and July 2007. The majority underwent TTI for recurrent pleural effusions; three procedures were performed for pneumothorax. Patient characteristics are detailed in Table 1. The mean age was 67 ± 13 years, and 47% were women. Malignant pleural effusion accounted for 75.5% of pleural effusions. The median talc dose was 6 g, and the mean period of chest tube drainage was 4.3 days.
All patients were followed until death, last
Discussion
The use of talc to achieve pleurodesis was initially described by Norman Bethune in 1935.15 Talc can be administered as slurry through a chest tube or insufflated during thoracoscopy. Comparisons of TTI and talc slurry pleurodesis have yielded conflicting results. A 2004 Cochrane review concluded talc was the most efficacious sclerosing agent and TTI was superior to bedside talc instillation.2 The Phase 3 Intergroup Study of TTI vs talc slurry was a prospective, randomized trial comparing the
Acknowledgments
Author contributions: Dr Gonzalez: participated in the study conception, completed the data collection, analyzed data, prepared the manuscript, and reviewed the data and the final manuscript.
Dr Bezwada: participated in the study conception, completed the data collection, and reviewed the data and the final manuscript.
Dr Beamis: participated in the study conception, and reviewed the data and the final manuscript.
Dr Villanueva: participated in the study conception, and reviewed the data and the
References (29)
- et al.
Talc pleurodesis for the treatment of pneumothorax and pleural effusion
Chest
(1994) - et al.
Adult respiratory distress syndrome following intrapleural instillation of talc
J Thorac Cardiovasc Surg
(1983) - et al.
Acute pneumonitis with bilateral pleural effusion after talc pleurodesis
Chest
(1984) - et al.
Respiratory failure due to insufflated talc
Lancet
(1997) - et al.
Respiratory failure following talc pleurodesis
Am J Surg
(1999) - et al.
Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study
Lancet
(2007) - et al.
Talc preparations used for pleurodesis vary markedly from one preparation to another
Chest
(2001) - et al.
Medical thoracoscopy. Technical details
Clin Chest Med
(1995) Pleural poudrage: new technique for the deliberate production of pleural adhesion as preliminary to lobectomy
J Thorac Surg
(1935)- et al.
Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion
Chest
(2005)
Pleurodesis using talc slurry
Chest
Thoracoscopy talc poudrage: a 15-year experience
Chest
Talc pleurodesis. Experience with 360 patients
J Thorac Cardiovasc Surg
Thoracoscopic talc poudrage pleurodesis for malignant effusions. A review of 360 cases
Chest
Cited by (0)
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).