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Published ahead of print on May 13, 2004, doi:10.1164/rccm.200311-1579OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 4, August 2004, 377-382

A more recent version of this article appeared on August 15, 2004
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Submitted on November 22, 2003
Accepted on May 10, 2004

Randomised Trials Describing Lung Inflammation After Pleurodesis with Talc of Varying Particle Size

Nick A Maskell1*, Y.C. Gary Lee1, Fergus V Gleeson1, Emma L Hedley1, Gerry Pengelly1, and Robert J.O. Davies1

1 Oxford Centre for Respiratory Medicine, Oxford Pleural Disease Clinic, Churchill Hospital, Oxford Radcliffe NHS Trust, Oxford, Oxfordshire, United Kingdom

* To whom correspondence should be addressed. E-mail: nickmaskell{at}doctors.org.uk.

We report two trials describing whether talc pleurodesis with mean particle size < 15 um (mixed talc) produces more lung and systemic inflammation than tetracycline or graded talc (most particles < 10 um removed). Firstly, 20 patients with malignant effusions received tetracycline or mixed talc. Changes in lung and systemic inflammation from lung clearance scans, oxygen saturations and C-reactive protein from baseline to 48 hours after pleurodesis were recorded. Lung inflammation (change in isotope clearance, talc -9.26 SD 14.3 v tetracycline +4.10 SD 13.8 minutes, diff -13.4, 95% CI -26.6 to -0.2, p=0.05), and systemic inflammation (change in C-reactive protein, talc 198 SD 79.2 ug/L, v tetracycline 74 SD 79.4 ug/L, diff. 124, 95% CI 50 to 199 p=0.004) were greater after talc. Secondly, 48 patients received mixed or graded talc and gas exchange was assessed from changes in Alveolar-arterial oxygen gradient. Mixed talc worsened gas exchange (oxygen gradient change, mixed 2.17 SD 1.74 kPa, 16.3 13.1 mmHg versus graded, 0.72 SD 2.46 kPa 5.4 18.5 mmHg, diff. 1.45, 95% CI 0.2 to 2.7, p=0.03) and induced more systemic inflammation than graded talc. We conclude the routine use of graded talc for pleurodesis would reduce the morbidity of this procedure.
Key words: Pleurodesis, Pleural effusion, Talc, Side effects, Acute respiratory distress syndrome (ARDS)




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