Inflammation and Clinical Repercussions of Pleurodesis Induced by Intrapleural Talc Administration

Genofre, Eduardo H.; Marchi, Evaldo; Vargas, Francisco Suso

doi:10.1590/s1807-59322007000500015

Cited by 32 publications

(17 citation statements)

References 37 publications

(50 reference statements)

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“…There is evidence that thoracoscopy – like many other interventional procedures – can provoke systemic inflammation, but it is clear that talc pleurodesis induces a stronger reaction in many cases [55,56]. In an experimental study on talc slurry treatment in rabbits, prominent perivascular infiltrates were found in the underlying lung, and the authors speculated that some mediators might spread from the pleura to the pulmonary circulation [57].…”

Section: Mechanisms Associated With Complications Of Pleurodesismentioning

confidence: 99%

Mechanisms of Pleurodesis

2012

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Pleurodesis aims to obliterate the pleural space by producing extensive adhesion of the visceral and parietal pleura, in order to control relapse of either pleural effusions (mostly malignant) or pneumothorax. A tight and complete apposition between the two pleural layers is a necessary condition to obtain a successful pleurodesis, but – besides this mechanical aspect – there are many biological mechanisms that appear to be common to most of the sclerosing agents currently used. Following intrapleural application of the sclerosing agent, diffuse inflammation, pleural coagulation-fibrinolysis imbalance (favoring the formation of fibrin adhesions), recruitment and subsequent proliferation of fibroblasts, and collagen production are findings in the pleural space. The pleural mesothelial lining is the primary target for the sclerosant and plays a pivotal role in the whole pleurodesis process, including the release of several mediators like interleukin-8, transforming growth factor-β and basic fibroblast growth factor. When the tumor burden is high, normal mesothelial cells are scarce, and consequently the response to the sclerosing agent is decreased, leading to failure of pleurodesis. Also, the type of tumor in the pleural cavity may also affect the outcome of pleurodesis (diffuse malignant mesothelioma and metastatic lung carcinomas have a poorer response). There is general agreement that talc obtains the best results, and there are also preliminary experimental studies suggesting that it can induce apoptosis in tumor cells and inhibit angiogenesis, thus contributing to a better control of the malignant pleural effusion. There is concern about complications (possibly associated with talc but other agents as well) related to systemic inflammation and possible activation of the coagulation cascade. In order to prevent extrapleural talc dissemination, large-particle talc is recommended. Although it could – to some degree – interfere with the mechanisms leading to pleurodesis and a carefully balanced clinical decision has therefore to be made, prophylactic treatment with subcutaneous heparin is recommended during hospitalization (immediately before and after the pleurodesis procedure).

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Section: Mechanisms Associated With Complications Of Pleurodesismentioning

confidence: 99%

Mechanisms of Pleurodesis

2012

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“…Postpleurodesis respiratory failure, which can be fatal, (15)(16)(17)(18)(19)(20) was not reported by the respondents in our study, and the reported incidence of empyema after pleurodesis ranged from 5% to 14%. However, we could not determine whether the occurrence of empyema was associated with a specific pleurodesis agent or whether it occurred in patients with poor performance status or inadequate lung expansion.…”

Section: Survivalmentioning

confidence: 51%

Pleurodese nos derrames pleurais malignos: um inquérito entre médicos em países da América do Sul e Central

et al. 2010

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Objective: Pleurodesis is an effective alternative for the control of malignant pleural effusions. However, there is as yet no consensus regarding the indications for the procedure and the techniques employed therein. The objective of this study was to evaluate how pleurodesis is performed in South and Central America. Methods: Professionals who perform pleurodesis completed a questionnaire regarding the indications for the procedure, the techniques used therein, and the outcomes obtained. Results: Our sample comprised 147 respondents in Brazil, 49 in other South American countries, and 36 in Central America. More than 50% of the respondents reported performing pleurodesis only if pleural malignancy had been confirmed. However, scores on dyspnea and performance status scales were rarely used as indications for the procedure. Nearly 75% of the respondents in Brazil and in Central America preferred to perform pleurodesis only for recurrent effusions and stated that lung expansion should be 90-100%. Talc slurry, instilled via medium-sized chest tubes, was the agent most often employed. Thoracoscopy was performed in less than 25% of cases. Fever and chest pain were the most common side effects, and empyema occurred in ≤ 14% of cases. The mean survival time after the procedure was most often reported to be 6-12 months. Conclusions: There was considerable variation among the countries evaluated in terms of the indications for pleurodesis, techniques used, and outcomes. Talc slurry is the agent most commonly used, and thoracoscopy is the technique of choice in Brazil. Pleurodesis is an effective procedure that has few side effects, as evidenced by the low complication rates and high survival times.Keywords: Pleural effusion, malignant; Pleura; Pleurodesis. ResumoObjetivo: A pleurodese é uma alternativa eficaz no controle dos derrames pleurais malignos, mas existem controvérsias a respeito de sua indicação e técnica. O objetivo deste estudo foi avaliar como é realizada a pleurodese em países da América do Sul e Central. Métodos: Profissionais que realizam pleurodese responderam um questionário sobre critérios de indicação para pleurodese, técnicas utilizadas e desfechos. Resultados: Nossa amostra envolveu 147 profissionais no Brasil, 49 em outros países da América do Sul e 36 em países da América Central. Mais de 50% dos participantes realizavam pleurodese somente se confirmada a malignidade no derrame pleural. Entretanto, escalas de dispneia e de status de performance eram raramente utilizadas para indicar o procedimento. Aproximadamente 75% dos participantes no Brasil e na América Central preferiam realizar a pleurodese somente no caso de recidiva do derrame, e a expansão pulmonar deveria variar de 90% a 100%. O talco slurry foi o agente mais utilizado, instilado via drenos de calibre intermediário. A toracoscopia foi realizada em menos de 25% dos casos. Febre e dor torácica foram os efeitos adversos mais comuns, e empiema ocorreu em ≤ 14% dos casos. A média de sobrevida após o procedimento variou entre 6 e 12...

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“…Talc use can induce intense intrapleural inflammation by producing numerous profibrotic factors that cause adhesions and fibrosis between the pleural membranes [7]. Common side effects of talc include fever (10-17%), pain, and gastrointestinal symptoms.…”

Section: Discussionmentioning

confidence: 99%

Pleurodesis with pseudomonas aeruginosa-mannose–sensitive hemagglutinin for pneumothorax secondary to COPD: a retrospective study

Luo

Tan

et al. 2017

COPD Res Pract

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Background: Pneumothorax is a potentially life-threatening complication of chronic obstructive pulmonary disease (COPD) that leads to cardiopulmonary compromise. According to the British Thoracic Society (BTS) guidelines, medical pleurodesis is recommended for inoperable patients suffering from COPD-related pneumothorax. Several sclerosing agents are currently in use, but none have been proven to be the best choice, as each one has effectiveness and safety issues. Recent research has shown that Pseudomonas aeruginosa-mannose-sensitive hemagglutinin (PAMSHA) is a safe bioagent with low toxicity and good immune-boosting effects that can induce the aseptic inflammation necessary to cause pleural adhesion. The aim of this study is to report our experience using PAMSHA in medical pleurodesis to treat inoperable cases of persistent pneumothorax secondary to COPD. Methods: Records of 78 inoperable patients with persistent pneumothorax secondary to COPD treated with PAMSHA pleurodesis were retrospectively reviewed. Pleurodesis was performed by administering 1 ml of PAMSHA (mixed with lidocaine and 30-40 ml of normal saline) intrapleurally. Results: The resolution of pneumothorax was observed in all of the patients treated with PAMSHA pleurodesis (success rate = 100%). Some of them experienced mild chest pain and fever, but no long-term side effects were reported. Conclusion: Our data suggest that PAMSHA pleurodesis is a safe and effective option for the treatment of persistent pneumothorax secondary to COPD.

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Inflammation and Clinical Repercussions of Pleurodesis Induced by Intrapleural Talc Administration

Cited by 32 publications

References 37 publications

Mechanisms of Pleurodesis

Mechanisms of Pleurodesis

Pleurodese nos derrames pleurais malignos: um inquérito entre médicos em países da América do Sul e Central

Pleurodesis with pseudomonas aeruginosa-mannose–sensitive hemagglutinin for pneumothorax secondary to COPD: a retrospective study

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