Predictors of acute lung injury and severe hypoxemia in patients undergoing operative talc pleurodesis.
BACKGROUND
Acute lung injury (ALI) is a life-threatening complication of talc pleurodesis. This study defines characteristics that predispose patients to ALI and severe hypoxemia in patients after video-assisted thoracoscopic surgery (VATS) talc pleurodesis.


METHODS
Charts of patients who underwent talc pleurodesis at Northwestern Memorial Hospital between January 1, 1997 and December 31, 2003 were retrospectively reviewed. We sought variables associated with the development of postoperative ALI or severe hypoxemia, defined as an increase in fraction of the inspired oxygen by more than 0.15 within 24 hours after the surgery. The analysis included 84 patients (58 women, 26 men) who underwent VATS talc pleurodesis for malignant (n = 74) or benign (n = 10) indications.


RESULTS
ALI developed in 5 patients (5.9%), severe hypoxemia developed in 25 (29.8%), and 54 (64.3%) did not have postoperative complications. In multivariate analysis, the presence of peripheral edema before pleurodesis (p = 0.005), any preoperative requirement for supplemental oxygen (p = 0.032), and chemotherapy within 14 days before pleurodesis (p = 0.04) were identified as predictors of ALI or severe postoperative hypoxemia.


CONCLUSIONS
Oxygen supplementation, recent chemotherapy, and presence of peripheral edema were independent predictors of a combined outcome of ALI or severe hypoxemia after VATS talc pleurodesis. Patients with these characteristics might be at risk for adverse outcomes of talc pleurodesis and should be considered for alternative therapy for their effusions.
Kuzniar
Tomasz J
TJ
Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. kuzniar.tomasz@mayo.edu
Blum
Matthew G
MG
Kasibowska-Kuzniar
Kamilla
K
Mutlu
Gökhan M
GM
D000368:Aged; D000970:Antineoplastic Agents; D004487:Edema; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D010996:Pleural Effusion / Q000601:surgery; D018700:Pleurodesis / Q000009:adverse effects* / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012597:Sclerosing Solutions / Q000009:adverse effects*; D013627:Talc / Q000009:adverse effects*; D020775:Thoracic Surgery, Video-Assisted
D000970:Antineoplastic Agents; D012597:Sclerosing Solutions; D013627:Talc