Lung injury following thoracoscopic talc insufflation: experience of a single North American center.
BACKGROUND
Thoracoscopic talc insufflation (TTI) has been used to obliterate the pleural space and prevent recurrent pleural effusions or pneumothorax. Reports of acute pneumonitis and ARDS after the use of talc raised concern about its safety. Differences in particle size of various talc preparations may explain the variable occurrence of pneumonitis. We sought to determine the incidence of lung injury after TTI over a 13-year period at our institution.


METHODS
Patients who underwent TTI between January 1994 and July 2007 were identified from a prospectively maintained logbook. The talc used was commercially available sterile talc (Sclerosol). The hospital course was reviewed in detail, and all cases of respiratory insufficiency were examined with regard to onset, suspected cause, and outcome. Talc-related lung injury was defined as the presence of new infiltrates on chest radiograph and increased oxygen requirements, with no other identifiable trigger than talc exposure.


RESULTS
A total of 138 patients underwent 142 TTIs for recurrent pleural effusions or spontaneous pneumothorax. TTI was performed most frequently for malignant pleural effusions (75.5% of effusions). The median dose of talc was 6 g (range, 2-8 g). Dyspnea with increased oxygen requirements developed within 72 h postprocedure for 12 patients. Four patients (2.8%) had talc-related lung injury, and talc exposure may have contributed to the respiratory deterioration in four additional patients.


CONCLUSIONS
We report the occurrence of lung injury after TTI using the only talc approved by the US Food and Drug Administration. These results reinforce previous concerns regarding the talc used for pleurodesis in North America.
Gonzalez
Anne V
AV
Montreal Chest Institute, McGill University Health Centre, 3650 Saint-Urbain St K1.09, Montreal, QC, Canada H2X 2P4. anne.gonzalez@mcgill.ca
Bezwada
Vishnu
V
Beamis
John F
JF
Villanueva
Andrew G
AG
D055371:Acute Lung Injury / Q000139:chemically induced* / Q000000981:diagnostic imaging; D000368:Aged; D005260:Female; D006801:Humans; D007327:Insufflation / Q000009:adverse effects; D008297:Male; D010316:Particle Size; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018700:Pleurodesis / Q000009:adverse effects*; D011014:Pneumonia / Q000139:chemically induced* / Q000000981:diagnostic imaging; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011446:Prospective Studies; D012008:Recurrence; D015996:Survival Rate; D013627:Talc / Q000009:adverse effects*; D013906:Thoracoscopy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
D013627:Talc