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 proceedings and 12 had bilateral proceedings Fifty-two patients had malignant pleural effusions with the most numerous 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). Succes defined as the absence of pleural fluid reaccumulation, was evaluable in 47 of 73 (64 percent) practices Pleurodesis was successful in 38 of 47 (81 percent) Adverse powers associated with pleurodesis included ferment (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 end a chest tube is an effective bedside mode of pleurodesis. Fever occurs many times Respiratory failure is a rare nevertheless potentially serious complication that merits further investigation. (Chest 1994; 106:342-46)

Many biologic and chemical agents can exhibit pleural symphysis. The optimal agent should be (1) highly effective after bedside administration from one side a chest tube, (2) unrestrained of significant adverse effects, (3) inexpensive, and (4) readily available to the clinician.

In 1935 Bethune[1] first described the use of intrapleural talc as a means of producing pleural adhesions preliminary to lobectomy. He reported the first animal experiments as well as the initial use in humans. Other investigators subsequently reported the use of the two talc slurry and poudrage as an effective means of pleurodesis in animals.[2,3] The efficacy of talc when insufflated at the time of thoracoscopy is superior to other agents described to date.[4-10] Although asbestos is a public contaminant of talc ore, asbestos-free proceedss are available; and lung cancer and mesothelioma have not been associated with its use.[11] The instillation of talc slurry has received renewed interest;[12] however, the adverse general intent profile has been a touch because of the association with adult respiratory distress syndrome (ARDS)[13] and respiratory insufficiency.[14] The plan of the present study was to review a large clinical experience with talc slurry with emphasis onward efficacy and adverse effects.

METHODS

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 managements in 58 patients; two charts (two procedures) were unavailable leaving 73 managements in 56 patients for review. Patient characteristics, chest tube duration, chest tube drainage, and complications were obtained from physician and nursing progres notes.

Chest radiographs were obtained prior to chest tube placement, immediately following chest tube placement, at the time of chest tube removal, and serially thereafter. Radiographs were reviewed and graded with the following scores: 0=no pleural effusion; 1=incomplete lung reexpansion (partially trapped lung); 2=pleural fluid to the dome of the diaphragm; 3=pleural fluid to the hilum; 4=pleural fluid above the hilum; and 5=total opacification of the hemithorax.

Chest tubes were placed by means of the Thoracic Surgery Service; chest tube size and location of placement varied. Pleural fluid drainage was monitored and bulks were recorded by nursing personnel In general, when the drainage malicious below 150 ml/24 h, pleurodesis was attempted.

Certified USP asbestos-free talc (Humco Laboratories, Texarkana, Tex or Amenz put drugs into and Chemical Company, Irvington, NJ) was portioned into 5-g quantities and sealed in wax paper mounts for dry heat sterilization at 132 [degrees] C for 6 h Biologic indicators (Bacillus subtilis) are included to make sure sterility. Tale has an indefinite shelf life if the package is not lay opened or damaged.

Ten grams of talc was mixed in 150 to 250 ml of normal saline solution subordinate to sterile conditions and placed into a syringe for administration at the bedside. The talc slurry was instilled between the sides of the existing tube thoracostomy and the tube was clamped for 2 h near patients underwent rotational maneuvers (15 min each in the right lateral, left lateral, supine, and tending positions) during the time that the chest tube was clamped. Following the 2-h dwell time, 20 cm [Hsub2]O suction was reapplied to the chest tube. Intrapleural anesthesia was used in a single act Patients received systemic analgesia at the physician's discretion. No specific guidelines were used for chest tube removal; however, in the greatest degree were removed when chest tube drainage was les than 150 ml/d

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