Distribution of Calibrated Talc After Intrapleural Administration

Fraticelli, A.; Robaglia-Schlupp, Andrée; Riera, Helene; Monjanel-Mouterde, Suzanne; Cau, Pierre; Astoul, Philippe

doi:10.1378/chest.122.5.1737

Cited by 72 publications

(34 citation statements)

References 20 publications

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“…More recently, another experimental animal study using calibrated talc for pleurodesis and repeating the same protocol did not show any systemic dissemination of talc particles ( fig. 3) [75,77].…”

Section: Intrapleural Instillation Of Sclerosing Agentsmentioning

confidence: 99%

Management of spontaneous pneumothorax: state of the art

Jm¹,

Rami–Porta²,

Noppen³

et al. 2006

European Respiratory Journal

191

141

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Spontaneous pneumothorax remains a significant health problem. However, with time, there have been improvements in pathogenesis, diagnostic procedures and both medical and surgical approaches to treatment.Owing to better imaging techniques, it is now clear that there is almost no normal visceral pleura in the case of spontaneous pneumothorax, and that blebs and bullae are not always the cause of pneumothorax. In first episodes of primary spontaneous pneumothorax, observation and simple aspiration are established first-line therapies, as proven by randomised controlled trials. Aspiration should be better promoted in daily medical practice. In the case of recurrent or persistent pneumothorax, simple talc poudrage under thoracoscopy has been shown to be safe, cost-effective and no more painful than a conservative treatment using a chest tube. There are also new experimental data showing that talc poudrage, as used in Europe, does not lead to serious side-effects and is currently the best available pleural sclerosing agent.Alternatively, surgical techniques have considerably improved, and are now less invasive, especially due to the development of video-assisted thoracoscopic surgery. Studies suggest that video-assisted thoracoscopic surgery may be more cost-effective than chest tube drainage in spontaneous pneumothorax requiring chest tube drainage, although it is more expensive than simple thoracoscopy and requires general anaesthesia, double-lumen tube intubation and ventilation.Recommendations are made regarding the treatment of pneumothorax. In secondary or complicated primary pneumothorax, i.e. recurrent or persistent pneumothorax, some diffuse treatment of the visceral pleura should be offered, either by talc poudrage under thoracoscopy or by video-assisted thoracoscopic surgery. Moreover, all of these new techniques should be better standardised to permit comparison in randomised controlled studies.

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Section: Intrapleural Instillation Of Sclerosing Agentsmentioning

confidence: 99%

Management of spontaneous pneumothorax: state of the art

Jm¹,

Rami–Porta²,

Noppen³

et al. 2006

European Respiratory Journal

191

141

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“…It is not clear so far whether the method of administration (slurry versus poudrage) plays a major role in the development of respiratory failure; further experimental studies are needed to answer this question. However, recent publications have pointed out the importance of the quality of talc and the size of talc particles in the safety of pleural symphysis [96][97][98][99].…”

Section: Surgical Managementmentioning

confidence: 99%

“…Immediate talc poudrage can be carried out in cases of macroscopic or histological evidence of malignancy and ineligibility of the patient for trials of intrapleural treatment. The safety and quality of such talc pleurodesis depends on the type of talc used [96], as well as the drainage technique and the time when pleurodesis is performed [84]. The chest tube must be inserted as low as possible in the thorax, directed posteriorly toward the costovertebral gutter, and as close to the apex as possible for optimal drainage of residual fluid, according to the Marseille school.…”

Section: Surgical Managementmentioning

confidence: 99%

Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion

Rodríguez-Panadero

Janssen²,

Astoul³

2006

European Respiratory Journal

154

111

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“…T alc powder is the most inexpensive and efficient agent for pleurodesis, as shown in human [1][2][3] and animal studies [4]. In a prospective cohort study, JANSSEN et al [5] recently demonstrated that thoracoscopic large-particle talc poudrage is safe in the treatment of malignant pleural effusions.…”

mentioning

confidence: 99%

Short-term safety of thoracoscopic talc pleurodesis for recurrent primary spontaneous pneumothorax: a prospective European multicentre study

Po¹,

Jm²,

Cardillo³

et al. 2011

European Respiratory Journal

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The safety of talc pleurodesis is under dispute following reports of talc-induced acute respiratory distress syndrome (ARDS) and death. We investigated the safety of large-particle talc for thoracoscopic pleurodesis to prevent recurrence of primary spontaneous pneumothorax (PSP).418 patients with recurrent PSP were enrolled between 2002 and 2008 in nine centres in Europe and South Africa. The main exclusion criteria were infection, heart disease and coagulation disorders. Serious adverse events (ARDS, death or other) were recorded up to 30 days after the procedure. Oxygen saturation, supplemental oxygen use and temperature were recorded daily at baseline and after thoracoscopic pleurodesis (2 g graded talc).During the 30-day observation period following talc poudrage, no ARDS (95% CI 0.0-0.9%), intensive care unit admission or death were recorded. Seven patients presented with minor complications (1.7%, 95% CI 0.7-3.4%). After pleurodesis, mean body temperature increased by 0.41uC (95% CI 0.33-0.48uC; p,0.001) at day 1 and returned to baseline value at day 5. Pleural drains were removed after day 4 in 80% of patients.Serious adverse events, including ARDS or death, did not occur in this large, multicentre cohort. Thoracoscopic talc poudrage using larger particle talc to prevent recurrence of PSPS can be considered safe.

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Distribution of Calibrated Talc After Intrapleural Administration

Cited by 72 publications

References 20 publications

Management of spontaneous pneumothorax: state of the art

Management of spontaneous pneumothorax: state of the art

Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion

Short-term safety of thoracoscopic talc pleurodesis for recurrent primary spontaneous pneumothorax: a prospective European multicentre study

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