title: Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study.
abstract: BACKGROUND
  Talc is the most effective chemical pleurodesis agent for patients with malignant pleural effusion. However, concerns have arisen about the safety of intrapleural application of talc, after reports of development of acute respiratory distress syndrome in 1-9% of treated patients. Our aim was to establish whether use of large-particle-size talc is safe in patients with malignant pleural effusion.
  
  
  METHODS
  We did a multicentre, open-label, prospective cohort study of 558 patients with malignant pleural effusion who underwent thoracoscopy and talc poudrage with 4 g of calibrated French large-particle talc in 13 European hospitals, and one in South Africa. The primary endpoint was the occurrence of acute respiratory distress syndrome after talc pleurodesis.
  
  
  RESULTS
  No patients developed acute respiratory distress syndrome (frequency 0%, one-sided 95% CI 0-0.54%). 11 (2%) patients died within 30 days. Additionally, seven patients had non-fatal post-thoracoscopy complications (1.2%), including one case of respiratory failure due to unexplained bilateral pneumothorax.
  
  
  CONCLUSIONS
  Use of large-particle talc for pleurodesis in malignant pleural effusion is safe, and not associated with the development of acute respiratory distress syndrome.
authors.affiliation: Canisius Wilhelmina Hospital, Nijmegen, Netherlands. Electronic address: j.janssen@cwz.nl.
authors.forename: Julius P
authors.initials: JP
authors.lastname: Janssen
authors.affiliation: Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
authors.forename: Gareth
authors.initials: G
authors.lastname: Collier
authors.affiliation: Hôpital Sainte-Marguerite, Marseille, France.
authors.forename: Phillippe
authors.initials: P
authors.lastname: Astoul
authors.affiliation: Spedali Civili, Brescia, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Tassi
authors.affiliation: University Hospital UZ Brussels, Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Noppen
authors.affiliation: Hospital Universitario Virgen del Rocio Sevilla, Seville, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodriguez-Panadero
authors.affiliation: Lungenklinik Heckeshorn, Berlin, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Loddenkemper
authors.affiliation: Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
authors.forename: Felix Jf
authors.initials: FJ
authors.lastname: Herth
authors.affiliation: Azienda Ospedali Riuniti, Ancona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Gasparini
authors.affiliation: Centre Hospitalier Régional Universitaire Lille, Lille, France.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Marquette
authors.affiliation: Johanniter-Krankenhaus, Treuenbrietzen, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Becke
authors.affiliation: University Hospital of Heraklion, Heraklion, Crete, Greece.
authors.forename: Marios E
authors.initials: ME
authors.lastname: Froudarakis
authors.affiliation: St. Elisabeth Ziekenhuis, Turnhout, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Driesen
authors.affiliation: Tygerberg Academic Hospital, Cape Town, South Africa.
authors.forename: Chris T
authors.initials: CT
authors.lastname: Bolliger
authors.affiliation: Centre Valaisan de Pneumologie, Montana, Switzerland.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Tschopp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010316:Particle Size; D016066:Pleural Effusion, Malignant / Q000209:etiology / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012449:Safety; D013627:Talc / Q000009:adverse effects / Q000627:therapeutic use*; D013906:Thoracoscopy; D016896:Treatment Outcome
chemical_list: D013627:Talc